Change Request: Add Trailer - North Town Insurance

Named Insured / Driver's Name*

First Last

Trailer: Year, Make, Model*

The year, make, model for Trailer you wish to quote

Trailer Style*

Please choose the style of the trailer. If it is not listed, please choose “Other” and make notes in the comments.

VIN*

Vehicle Identification Number for trailer being added. Or N/A if not applicable.

Date of Purchase*

When did you buy this trailer?

Coverages Requested*

We will use your existing coverage, unless other coverage options are requested here.

Are You the Registered Owner?*

YES if you are the registered owner. NO if there is another owner or co-owner and add their information in the Comments below. Or N/A if not applicable.

Is there any Existing Damage?*

No or Yes. For Yes, please describe location of body or glass damage in the comments below. Or N/A if not applicable.

Estimated Value / Full Purchase Price*

What is the estimated value of the trailer.

Will there be any Business Use?*

Please let us know if you use your vehicle for delivery or rideshare (i.e. Uber, Lyft), or there are Company logos on your vehicle.

Will you be adding any Custom or Aftermarket Parts?*

If you have added any custom or aftermarket parts, please describe WHAT and the VALUE in the comments.

Where will the Trailer be located?*

Will this trailer be primarily located at your address, or another location?

Trailer Length*

What is the length of the trailer?

Does the Trailer have Slides?*

If the trailer has slides, how many?

Lienholder/Additional Interest*

If there is a lienholder, leasing company or additional interest, please list them here. Or N/A if not applicable.

Comments/Additional Notes

Thank 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

By selecting the SUBMIT button, are you confirming that the information you provided is true and accurate?