Change Request: Add Vehicle

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Change 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?
If you want a QUOTE ONLY, please let us know here.
Client Name / Primary Policy Holder*
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.
For new purchases, when did you buy this vehicle?
Please note the year, make & model of the car you are removing/replacing. Leave blank if you’re not removing a vehicle. *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.
Current vehicle we are Removing/Replacing – do you still own this vehicle?
Please let us know if you still own the vehicle you are removing/replacing.
The year, make, model for vehicle you wish to add or NONE of no vehicles are being added.
Vehicle Identification Number for vehicle adding. Or N/A if not applicable.
What is the estimated value of the vehicle.
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.
No or Yes. For Yes, please describe location of body or glass damage in the comments below. Or N/A if not applicable.
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.
If you have added any custom or aftermarket parts
Yes if the vehicle is garaged at your primary residence. No, if not, and please describe in the Comments below.
About how many miles will you drive this car, annually? Generally below 7500 qualifies for low mileage discounts. Or N/A if not applicable.
Coverages Requested*
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.
If there is a lienholder, leasing company or additional interest, please list them here. Or N/A if not applicable.
If this is for a Business Auto policy, please let us know the GVW if you know it. Over or under a 1 ton is also helpful information.
If this is for a Business Auto policy, how will the vehicle be used? I.e. hauling equipment, transporting people or materials, etc.
If this is for a Business Auto policy, please let us know how far you are traveling for your business.
If this is for a Business Auto policy, are there any specific DOT Filings required for this business vehicle? I.e. E or H
If this is for a Business Auto policy, please let us know if this is a Dump Truck, Bucket Truck, Flatbed, etc.
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.
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?*
By selecting the SUBMIT button, are you confirming that the information you provided is true and accurate?
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