REQUEST TO ADD A VEHICLE TO MY AUTO POLICY Home » Request Policy Change » REQUEST TO ADD A VEHICLE TO MY AUTO POLICY Requestor Information First Name* Last Name* Email Address:* Phone Number:* We will confirm the policy change by email. If you prefer a FAX, please provide a FAX number. Policy Holder Information (if different than requestor) Policy Number (required if you have more than 1 auto policy) First Name Last Name Vehicle Information Vehicle to be Added Effective:* MM010203040506070809101112DD01020304050607080910111213141516171819202122232425262728293031YYYY2021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910 VIN (Vehicle Serial Number)* Year:* —Please choose an option—202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950 Make:* Model:* Collision Deductible:* —Please choose an option—$250 Deductible$500 Deductible$1000 Deductible Comprehensive Deductible:* —Please choose an option—$250 Deductible$500 Deductible$1000 Deductible Lienholder/Finance/Vehicle Information Name of owner(s) on the vehicle title: Is the vehicle leased or financed? If yes, please complete the following* YesNo Lienholder Name: Lienholder Address 1 Lienholder Address 2 City State —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Finance or Lease Term: Amount Leased or Financed: Driver Information Primary Driver for New Vehicle:* Is this a new driver? If yes, please complete remainder of section* YesNo New Driver Date of Birth: New Driver Date of Birth: New Driver License Number: New Driver License State: —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Questions or Comments Binding Agreement* (Required) I understand that any policy changes and quote requests are effective only when I have received a written confirmation This submission is a request. Insurance coverage changes and new coverage are not effective until we confirm that for you. We will do our best to complete this request based on the information you provide. The more complete your information, the more accurate your quote will be. Client Services File a Claim Request a Certificate Request ID Request Policy Change Get a Quote