Add a Vehicle

Use this form to add a vehicle on your existing policy. When changes are complete, review and check mark the Understanding of Change (last statement) then click the “Send Request” button at the bottom of the form.






Policy Name, Number and Contact
*Full Name:
*Policy Number:
Day Phone: (example: 509-555-1212)
–  ext.
*Email: (We respect the use of your email address)
Add Vehicle — Complete 1 form for each Additional Vehicle
If adding “other than collision’ or ‘collision’ coverage the agency will require you email us 2 photos showing all 4 sides of the vehicle or stop by the office for photos to be taken. Photos may be emailed to:
Registered Owner Name:
Year:
Make:
Model:
Sub-Model (ie: LX, GTI):
*Vehicle Identification Number (VIN):
How many doors?
2 doors    

4 doors
Convertible:
Yes    

No
4×4:
Yes    

No
Vehicle Usage:
Miles to work one-way:


Other than Collision Deductible:
Definition
Collision Deductible:
Definition
Any damage to vehicle?
Yes**    

No
Any special equipment?
Yes**    

No
Vehicle modified or salvaged?
Yes**    

No
   
Additional Information

* I understand that no changes will go into effect until I sign the change request that the agency will email me.

* Required Fields
** If answer is Yes please describe in Additional Information field


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