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📞 509-248-2100
Get a Quote
Auto Insurance Quotes
Home Insurance Quotes
Life Insurance Quote
Information
Our Companies
Make a Payment
Proof of Insurance Request
Add or Replace a Vehicle
State Requirements
File a Claim
Insurance
Auto Insurance
Home Insurance
Life Insurance
Add or Replace a Vehicle
Casey
2021-08-27T09:44:52-07:00
Add or Replace a Vehicle Request
Requester Name
*
First
Last
Requester Phone
*
Requester Email
*
I certify I am the Named Insured on this policy change request
*
Yes I agree
Policy Number if Known
Effective Date of Change Request
*
MM slash DD slash YYYY
Are you replacing a vehicle?
*
Yes
No
Which vehicle are you removing? (year/make/model)
*
Reason for removal
*
Vehicle Sold
Vehicle not operable
Vehicle not being used
Other
Date of Sale
*
MM slash DD slash YYYY
Upload bill of sale (optional)
Max. file size: 128 MB.
New Vehicle Info
Year of vehicle are you adding
*
What is the VIN# (Vehicle to be added)
*
How is the vehicle primarily used?
*
To and From Work/School (Commute)
Pleasure
Business
Tell us more about your business usage
*
Please select the option that most resembles how you use this vehicle.
Sales - (Drive to customer home or business)
Contractor - (Drive to Jobsite)
Delivery - (Delivery of any kind)
Livery - (Transporting of clients/customers)
Other - Not otherwise classified
Is this Vehicle Used for Rideshare or Food Delivery (Uber, Uber Eats, Instacart, Door Dash etc.)?
*
No
Yes
How many miles per year is it driven?
*
Between 5,001 - 12,000 annually
5,000 or less annually
More than 12,000 annually
How many miles ONE way to work?
*
Your best guess is okay
Is this a NEW purchase?
*
Yes
No
Purchase date
*
MM slash DD slash YYYY
Do you need full coverage?
*
(Full coverage in this form means Comprehensive and Collision coverage only)
Yes
No
What deductible would you like for Comprehensive?
*
Comprehensive is damage or loss from incidents "Other than a Collision" such as Fire or Theft.
Same as my other vehicles with Full Coverage
100
250
500
1000
What deductible would you like for Collision?
*
Collision is damage or loss from incidents a motor vehicle collision not matter of fault.
Same as my other vehicles with Full Coverage
250
500
1000
Do you want Roadside Assistance/Towing Coverage
*
Yes
No
Third Choice
Do you want Rental Car Coverage?
*
Yes
No
Is the car registered to you?
*
If registered to a legal spouse enter yes.
Yes
No
Name and Address of Registered Owner
Name of Registered Owner
Mailing Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Do you have a loan on this vehicle?
*
No
Yes
Name of Legal Owner (Lienholder/Bank)
*
Upload Registration or New Purchase Paperwork Here (Optional)
Max. file size: 128 MB.
Leave any special requests here.
Warning
Warning: It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines, and denial of insurance benefits. You must be the Named Insured on the policy to submit a policy change request.
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