Change Request: Suspended Vehicle Coverages (single vehicle) This form is for Suspending or Reinstating coverage on existing vehicles. 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. Quote Only? No - Make this Change Yes - Quote Only If you want a QUOTE ONLY, please let us know here. Client Name / Primary Policy Holder* 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.Current Vehicle To Be Updated (1)*Please note the year, make & model of the car you would like coverage changed on. Current Vehicle To Be Updated (2)Please note the year, make & model of the car you would like coverage changed on. Leave this blank if it applies to only 1 car. Suspend Coverage 1 (Use if you want to REMOVE COVERAGE) Yes - I request to suspend coverage Not Yet - I would like more information about this This option is for a seasonal use vehicle that is not being driven for months at a time. Coverages removed are: liability, medical or personal injury protection, uninsured motorist, collision and any other coverages besides Comprehensive. Suspend Coverage 2 (Use if you want to Remove Coverage) Yes - I acknowledge No - Change declined You acknowledge that the vehicle will not have driving coverage and that we will need at least 48 business hours advance notice before you plan to drive the car again. *We will be emailing you a confirmation to esign for this request. Garaging/Physical LocationWhat address will the vehicle(s) be physically located? Estimated TimeframePlease estimate how long this storage coverage may be needed for. Comments/Additional NotesThank you for using our online form! If you have any additional notes, questions or comments, please note them here. *NOTE: One of our team members will send you 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! Your Name (Who is filling out this form?)*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?* Yes No By selecting the SUBMIT button, are you confirming that the information you provided is true and accurate?
