Other Requests any other change or additional information on your existing policy. When done, 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) Other Change or Additional Information Please describe any other change you need done or any information that will help us process your change request: When your change request is received by Mid-Columbia Insurance, a change form will be emailed back to you showing the changes we have made. If the changes are correct, follow the instructions for doing an e-signature. If you do not receive our change form by the next business day, please call us. * I understand that no changes will go into effect until I sign the change request that the agency will email me. * Required Fields Share this:Click to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on Pinterest (Opens in new window)Click to share on LinkedIn (Opens in new window)MoreClick to print (Opens in new window)Click to email this to a friend (Opens in new window)
