Form

Vehicle Change Request*

First name

Last name

Email*

Effective Date Of Change*

What date would you like this change to be made to your policy?

Month-Day-Year

Quote Only?*

If you have already purchased this vehicle, we recommend adding it to your policy immediately. Generally, you can expect similar cost to other like vehicles on your policy with similar coverage. If you are unhappy with the cost of the change, we can always look for alternatives.

Year*

Make*

Model*

VIN*

Do you drive for Uber, Lyft, or any other ridesharing or food delivery network or use your vehicle for commercial purposes of any kind?*

Yes

Are you willing to provide details about your driving habits to your insurance company in exchange for a discount?*

The use of telematics in auto insurance is a growing trend with many insurance companies. In these usage-based insurance plans, insurance companies rely on telematics devices plugged in to your vehicle, or an app on your cell phone to monitor driving habits and tendencies, tracking drivers' speed, mileage, and total driving time to more accurately determine car insurance premiums. Most insurance companies provide a discount on your premium in exchange for participation ranging from 10-50%. **Not available with all carriers.

Comprehensive Deductible*

Comprehensive coverage covers your vehicle against loss caused by things other than collision. Some common examples would be vandalism, hail damage, theft, or acts of God.

Collision Deductible*

Collision insurance is a coverage that helps pay to repair or replace your car if it's damaged in an accident with another vehicle or object, such as a fence or a tree. If you're leasing or financing your car, collision coverage is typically required by the lender.

Full Glass Coverage*

Provides coverage for glass breakage with a reduced or no deductible. This typically increases the overall cost of the policy.

Rental Reimbursement*

Provides coverage for a replacement vehicle due to a covered loss

Towing & Roadside Assistance*

Loan/Lease Coverage*

If your vehicle is stolen or totaled in an accident and you have loan/lease payoff coverage, we'll pay the difference between your vehicle's value and what you owe on it, up to 25% of your vehicle's value (though the exact limit can vary by state). If your claim is approved, we'll send the payment to your loan or lease provider. Note that loan/lease payoff doesn't cover additional charges related to your loan or lease, such as excess mileage fees.

Will you be making payments on this vehicle?*

If so please provide the name AND address of the bank, dealership or other party you will be making payments to.

Lienholder Name

Lienholder Address

Lienholder City

Lienholder State

Lienholder Zip

Is this a personal or commercial vehicle?*

Vehicle Type*

Stated Value*

How much is the vehicle currently worth

Cargo Coverage*

Provides Coverage for items hauled or transported commercially for others. (does not apply to personal insurance policies)

Will this vehicle be replacing another vehicle on your policy? If so please provide the Year, Make And Model of the vehicle you wish to be replaced.*

Would you like to enroll this vehicle in a telematics program in exchange for a potential 5-50% savigs?*

Telematics programs allow your insurance provider to monitor your driving habits and adjusts your car insurance premiums based on how you drive. They’ll monitor your driving through a small device installed in your car's diagnostic port, or a mobile phone app. Your provider will be able to track things like your driving speed, how you brake and how you handle corners. The more responsibly you drive, the lower your premiums are likely to be in the future. You’ll also be able to see your own driver score, either on the insurer’s website or smartphone app. Most carriers provide a 10% initial discount for participation, followed by the discount you earn based upon your results. This discount will remain on your policy as long as you own the vehicle. ****Not available with all insurance companies.****

Any special instructions or requests?