Option 1: The consumer declines insurance and/or increased valuation. Any damages will be reimbursed at a value of $ 1.00 per pound per article.
Option 2: Increased valuation: The agreed or declared value of the property is specifically stated by the consumer and confirmed by his or her signature to be $________________ for: the entire shipment or only the following articles _____________________.
Option 3: The consumer orders insurance of $_________________ including a deductible of $_______________________.";
N.J. Admin. Code § 13:44D-4.3