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004 -*Prepared on November 27, 2007 Page 1 of 4

On Your Side

Nationwide® CA Assoc 1 CA Ave

00001

Your Account Bill
Minimum Amount Due
Must be Received by Your Account Number

CA City, CA 08537

$70.80
November 17, 2007 7258170084
7204A 115004

See the reverse side for 24-Hour Claims Reporting and other contact information.

CA Assoc 614.249.7111 Access your account online at www.mynationwide.com

Auto Policy

Planning to move? We can help!!! Please visit nationwide.com/help memove

Auto Janregoeight 111 Test Regcity CA 12345

Account Summary Details of your account begin on page 3.
Previous Account Balance Last Payment Policy Added to Your Account Installment Fee Including Any Fees Auto Policy 7204A 115004 For Processing This Payment

Current Account Balance

Minimum Amount Due

$70.80

$0.00 0.00 334.00 4.00 $338.00

Please detach and mail this slip with your payment.

For Billing Terms and Conditions, and

Ways to Pay

Auto Janregoeight 111 Test Regcity CA 12345

Payment Slip
SAVE! Mail your payment
early to avoid a Late Fee.

Minimum Amount Due $70.80
Must be Received by November 17, 2007

Make payable to: Address Change? Account Number
7258170084

Nationwide Insurance
Please call 614.249.7111

Amount Enclosed

/917160068688/
Nationwide Mutual Insurance Company PO Box 60068 City Of Industry, CA 91716-0068

Your Nationwide Agent
CA Assoc 614.249.7111

03 0711170000 10 01 14 0058170084 4 0000007080 0000007080 72 1

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On Your Side

Nationwide®
Contact Us For questions about your policy contact:
CA Assoc

Information You Can Use

614.249.7111 CAASSOC@BILLING-TEST.COM
Hearing Impaired (TTY)

1.800.622.2421

24-Hour Claims Reporting

1.800.421.3535 Importante: Si usted tiene cualquier tipo de pregunta sobre su póliza de seguro o coberturas, por
favor comuníquese con su agente de seguros.

Ways to Pay Automatic Enroll in Nationwide's Easy Pay program and potentially save up to $96 per year. Your By mail Internet By phone

payments are automatically deducted monthly from your checking or savings account. Call us to sign up. Pay by personal check or money order mailed with your payment slip. At www.mynationwide.com you can pay by electronic check transfer, credit, or debit card. Call 614.249.7111 and pay by electronic check transfer, credit, or debit card.

Billing Terms · Any check, electronic payment, or debit/credit card payment refused by your bank may be and Conditions subject to a $20 fee. You may be charged a $5 fee for any payment received after the "Must be

Received by" date. · An installment fee is incurred with each installment payment, except when paying monthly with Easy Pay. To avoid future installment fees, pay your current account balance in full. · Full payment of the minimum amount due is required for continued coverage on ALL policies. · Payments are applied to any existing balances or fees first, then to the current balance due in the following order: Auto, Property, Commercial, and Life. · You may not be sent a bill for a balance due of $10 or less - the amount will appear on your next statement. · Some online billing options may not be available in your state. Visit www.mynationwide.com for options available in your area.

Are you sure you're ready for 2008?
Life Comes at You Fast ®, be ready with Nationwide. Whether it's reviewing your life insurance or updating your home insurance, be sure you're ready by getting a comprehensive CARE Review with your Nationwide Agent. Call and schedule it today so you can get on with 2008, knowing you're protected.

On Your Side

Nationwide®

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On Your Side

Nationwide®

Your Account Details
Your Account Number

Prepared on November 27, 2007 Page 3 of 4

7258170084

Auto
Policy Number: 7204A 115004 Insuring Company: Nationwide Assurance Company Renewal Date: 10/31/07

Policy Activity 10/31/07

Previous Policy Balance Policy was added and premium was charged

0.00 334.00 $334.00 Current Policy Balance Minimum Amount Due for this POLICY

$66.80 4.00 $70.80

Installment Fee For Processing This Payment

Minimum amount due for this ACCOUNT
See your Policy Declarations for your coverage details.

How to Contact Us
CA Assoc

614.249.7111

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On Your Side

Nationwide®

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