Auto Change Request

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Vehicle Change Request Form

Insured Information

Vehicle Change

Add    Delete
Yes    No

Covers damage to your vehicle caused by OTHER THAN COLLISION. (Including glass breakage, fire, theft, vandalism, hail, wind, fire, animal theft, vandalism, glass, hit animal)

Yes    No

Covers damage to your vehicle CAUSED BY COLLISION.


Driver Information

Yes    No

Bank Loan Information

Yes    No

Leased Vehicle Information

Yes    No

Driver Change

Adding    Deleting
Yes    No
Yes    No
If we have questions in processing your change:
Coverage Change

If you are adding a vehicle, your coverage will automatically be the same coverage as you have currently.

Other Changes

If there are not enough inputs in this form to report all the changes, please list that information below. If you wish to delete or adjust other coverage, please describe below. The specific coverage limits are described and shown in detail in your policy. Please outline below what you wish to change.

Important

If you are adding a vehicle, you will automatically get the same coverage as you had on your best vehicle including comprehensive and collision.

If no vehicle had comprehensive or collision coverage, we will bind it in force with a $50 deductible on comprehensive and a $250 deductible on collision unless you specify that it is not wanted either in (Other Changes) or is the (Add Vehicle).

If you would like to change your policy limits, we would like you to call or otherwise specify the change in the "Other Changes" area of this form.

We would be pleased to answer any question or make any change directly for you. Please call 1-877-468-7426. A knowledgeable customer service representative will answer your questions between the hours of 7:30 a.m. to 7 p.m. Monday through Thursday and 7:30 a.m. to 5 p.m. Friday and 8 a.m. to noon on Saturday.


Insurance coverage cannot be bound or changed via submission of the online form/application, email, voice mail, text, or facsimile. You will be contacted by a licensed insurance agent with confirmation of your request.

* = Required

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