diff --git a/src/layouts/coverage-statement/coverage-statement.vue b/src/layouts/coverage-statement/coverage-statement.vue
index 4e4dd4cc0..b295273f4 100644
--- a/src/layouts/coverage-statement/coverage-statement.vue
+++ b/src/layouts/coverage-statement/coverage-statement.vue
@@ -4,10 +4,42 @@
-
-
+
+
+
+
+
+
+
+
+
+
diff --git a/src/layouts/coverage-statement/customer-instructions/customer-instructions.vue b/src/layouts/coverage-statement/customer-instructions/customer-instructions.vue
new file mode 100644
index 000000000..d036e2ead
--- /dev/null
+++ b/src/layouts/coverage-statement/customer-instructions/customer-instructions.vue
@@ -0,0 +1,82 @@
+
+
+
+
+ {{ headerText }}
+
+
+
+
+
+
+
+
+
diff --git a/src/layouts/coverage-statement/price-display/price-display.vue b/src/layouts/coverage-statement/price-display/price-display.vue
new file mode 100644
index 000000000..23d0ca3f2
--- /dev/null
+++ b/src/layouts/coverage-statement/price-display/price-display.vue
@@ -0,0 +1,53 @@
+
+
+
+
+ {{ headerText }}
+
+
+
+ {{ priceText }}
+
+
+
+
+
+
+