Change Request: Remove Vehicle

"*" indicates required fields

Change Request Acceptance*

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.

Client Name / Primary Policyholder Name*

First Last

Quote Only?

No, make this change.

Yes, quote only.

If you want a QUOTE ONLY, please let us know here.

Change Effective Date*

Please let us know the date you’d like this change(s) effective. *If the request is to backdate the change (other than a Totaled vehicle), we will need proof of sale to provide the insurance company. That proof can be emailed to info@northtowninsurance.com.

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 Drivable

Totaled

Storage option (Comprehensive only)

Drivable, but don’t want the vehicle insured

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 Notes

Thank 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# for Text*

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?