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. Reinstate Coverage 1 (Use if you want to ADD COVERAGE) Liability Only (original policy wide coverage) Comprehensive - *theft, fire, vandalism, falling objects, glass, hitting an animal $0 Deductible Glass Coverage - if available Collision - *physical damage to your car if you hit a car or object Towing/Roadside Assistance - if available Rental Car - If available OEM Parts - if available Use Existing Coverage Limits We will use your existing coverage, unless other coverage options are requested here. If your existing coverage doesn't include Comprehensive or Collision, we will use $500 Deductibles - unless another amount is noted in the Comments. *Insurance details: https://www.insurance.wa.gov/whats-covered-under-auto-policyReinstate Coverage: Photos Required Drop files here or Select files Max. file size: 98 MB. In order to add coverage back to a vehicle, please upload a photo of each of the 4 sides of the vehicle and the VIN. This helps your carrier to confirm if there is or is not existing damage. We will need these photos in order to process the change.Reinstate Coverage 2 (Use if you want to Add Coverage) Yes - I acknowledge No - Change declined We ask for 48 business hours to add coverage back to a vehicle, that was in storage/suspended mode. You will receive confirmation from our team as soon as it has been updated. 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?
