Policy Changes April 8, 2020by xxxadmin1 Policy Changes Share Step 1 of 8 – Start Personal Information 12% Name* First Last Phone*Email Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Endorsement Type Change of Address Add Vehicle Delete Vehicle Add Driver Delete Driver Change Current AddressAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Add a VehicleVin Number*Covarges*Liability Only – Same As current policyComp/Collision 500/500 (*Full Coverage)Comp/Collision 1000/1000 (*Full Coverage)Basic full coverage please talk to an agent about additional coverages. If you have a Lien Holder – Company and AddressIf your leasing or buying your car please provide us with the name of the finance company and the address. Example Ford Credit – P O BOX 23830 TUCSON, AZ 85737 Delete a VehicleList*Make Or ModelYear Example Model = Ford F-150 Year = 2011 Add DriverAdd Driver*Drive NameDOB Example 01/02/1970 Coverage will start once we send you an application and we receive the signed application. Delete DriverDelete Driver*Drive Full NameDOB Example 01/02/1970 Consent Deleting a driver* I agree by deleting this driver they will be excluded from my policy.I agree by deleting this driver they will be excluded from my policy. This exclusion shall apply to the designated person(s) regardless of where they reside or whether they are licensed to drive, until the are added to the policy DOES NOT PROVIDE COVERAGE FOR ANY DRIVER NOT LISTED ON MY AUTO INSURANCE POLICY. Please list ALL persons over 14 years old who reside on your property or apartment address or may have regular access to your Vehicles, if you fail to declared OR give a false statement may your Insurance will be cancel o deny a claim, or set to none renewal: Signature*Consent age 14 – Accept by Checking box* I have listed all person (s) living in my household older than 14 years of age.This exclusion shall apply to the designated person(s) regardless of where they reside or whether they are licensed to drive, until the are added to the policy DOES NOT PROVIDE COVERAGE FOR ANY DRIVER NOT LISTED ON MY AUTO INSURANCE POLICY. Please list ALL persons over 14 years old who reside on your property or apartment address or may have regular access to your Vehicles, if you fail to declared OR give a false statement may your Insurance will be cancel o deny a claim, or set to none renewal:Accept by Checking box* No Coverage Until Signed Application. (If full Coverage, Photos are required)No Coverage Until Signed Application. You will receive an email indicating your coverage has begun. If you are covering a car with full coverage you must send us pictures. (If full Coverage, Photos are required) Δ
