Change Request Acceptance*I understandNo follow up neededChange Request Guidelines: Policy changes cannot be processed on a cancelled policy. Each carrier and policy has different requirements and we may be unable to backdate a request, offer requested coverage or have additional options to review. We will connect with you if your request is unable to be processed. Client Name / Primary Policyholder Name* First Last Change Effective Date* Please let us know the date you'd like this change(s) effective. If you would like a QUOTE ONLY, please let us know in the Comments below.Remove Vehicle / Motorcycle / ATV, etc* The year, make and model for the vehicle (or toy - motorcycle, ATV, etc) you wish to remove. *NOTE: If you still own the vehicle, there may be coverage options for "storage" that will remove the liability rate but still allow for some protection and maintaining a multi-vehicle discount. If you'd like to review those options, please add the the comments below. Reason for Removing Vehicle* Sold Not Driveable Storage option (Comprehensive only) Please choose the reason you're removing the vehicle. If you still own it, please let us know if we can review a Storage option (Comprehensive only) for you. Storage/Suspended Coverage Acknowledgement* N/A - I am fully removing a vehicle. Yes - Acknowledged. This coverage removes all coverages except Comprehensive (i.e. theft, fire, vandalism, falling objects, etc). There is no coverage for driving, uninsured motorist, personal injury protection. IMPORTANT: When you will be driving the suspended vehicle, our office or your insurance company needs at least 24 business hours notice to add the coverage and make the vehicle legal to drive. Comments/Additional NotesThank you for using our online form! If you have any additional notes, questions or comments, please note them here. *NOTE: You will receive a confirmation or follow up with additional questions within 24-48 business hours. Preferred Method of Confirmation *Include Email Address or Phone#* Please let us know if you prefer an email or text confirmation once the change is processed. If you have new contact information, please note that. Thank you! Who is filling out this form?* Please let us know your name and/or if you are the policy holder, household member, lender or agent.Approval & Verification: By SUBMITTING this form, are you confirming the information you provided is true and accurate?*YesNoBy selecting the SUBMIT button, are you confirming that the information you provided is true and accurate?
