Home
About Us
Overview
Our Team
Insurance Partners
Commercial Insurance
Overview
Farm Insurance
Property/CGL Insurance
Auto Insurance
Personal Insurance
Overview
Home Insurance
Tenants Insurance
Seasonal Dwelling
Rented Dwelling
Auto Insurance
Other
Boat Insurance
Motorcycle Insurance
Vacation Trailer
Personal Umbrella Liability
ATV & Snowmobile
Party Alcohol Liability
Tools & Resources
Overview
Insurance Tips
Downloadable Forms
Policy Change Forms
Address Change
Replace Vehicle
Add Vehicle
Delete Vehicle
Change Use of Vehicle
Claims
Automobile
Business
Property
Contact Us
Overview
Insurance Tips
Downloadable Forms
Policy Change Forms
Address Change
Replace Vehicle
Add Vehicle
Delete Vehicle
Change Use of Vehicle
Claims
Add Vehicle
Name(s) of insured(s)
1st insured:
2nd insured:
How can we reach you:
E-Mail
Phone
E-mail Address:
Daytime Telephone #:
Home telephone #:
Fax #:
New Vehicle
Vehicle make:
Year:
Model:
Condition at time of purchase:
Purchase Date:
Calendar
Purchase Price:
VIN (vehicle ID #):
Any non-factory modifications to the vehicle:
Yes
No
Any unrepaired damage:
Yes
No
If yes, specify:
Is vehicle leased or financed:
No
Leased
Financed
Names and address of leasing company lien holder:
Use of Vehicle:
Pleasure
Commuting
Business
Farming
Other
Comments (details if use is other):
Kilometers traveled per year:
0-5000
5001-10000
10001-15000
15001-20000
20001-25000
25001-30000
30001-over
How many kilometers one-way for daily commute:
N/A
0-5
6-8
9-16
17-24
25+
Will adding this vehicle result in changes in use of other:
Yes
No
Third party Liability coverage requested:
$1,000,000
$2,000,000
Collision coverage and deductible requested:
None
$500
$1000
Higher
If Higher, please specify:
Comprehensive coverage and deductible requested:
None
$300
$500
Higher
If higher, please specify:
All perils coverage and deductible requested:
None
$500
$1000
Higher
If higher, please specify:
Driver #1
Driver:
Date of Birth:
Calendar
Driver type:
Principal
Occasional
Driver #2
Driver:
Date of Birth:
Calendar
Driver type:
Principal
Occasional
Driver #3
Driver:
Date of Birth:
Calendar
Effective Date
When will this change be effective:
Calendar
About Your Insurance (Specify the policy to which this change applies)
Company:
Policy #:
Additional Comments:
Name of your broker: