Step 1 of 5 20% Policy #*Please provide us with the policy#, so we may figure out which policy we are adding this toYour Email* Your Cellphone Number*Please provide a call back number, in case we need to call you for additional information Date to add vehicle to your policy* If this is a purchase from a dealership, this will be the date you will drive the car home and off the dealership lot. or, if this is a private purchase, the date you own the carIs this vehicle leased or financed?*Yes, I am leasing or financing this vehicleNo, I purchase the car and paid in fullFinanced/Leased Cars - Lienholder Information*Please provide the bank or the lienholder to be added to your policy. Your dealer or bank will have this information. Do you want to send the proof of insurance to someone else?*YesNoUsually your bank or dealership/salesperson will need this information to complete the purchase/loan of the car. Proof of Insurance/Binder Recipient's Email* Who will this car be Registered and Titled to?*The name must match the license exactly, if the name on your license is John A. Smith, the correct registered name is "John A. Smith", not "John Smith" Vehicle Identification Number (VIN) of the car to be added to your policy*Are you getting new licesing plates or transferring plates from another car?*Yes, I am getting new license plates for this carNo, I will take the plates from another car and use the plates on this carWhich car are you taking the license plate from?*Please provide the year, make, model so we can match up the car and remove it from your policy correctly.What will you be using the new car for?*Weekend use and occasional trips (Pleasure use)To get around daily or as needed (Commute)Delivery, Uber, Lyft, Business (Business use) Do you want "Physical Damage" coverages, such as comprehensive, collision, full glass, roadside assistance, & rental reimbursement on this new vehicle?*YesNoWhat deductible do you want for physical damage coverage?*5001000The same as what I have on my policyDo you need to add any additional drivers to your policy?*YesNoYou must report all drivers, new drivers, in your household to the insurance company. New or Additional Driver(s) to be added the the policy*Full NameDate of BirthLicense # / Issued StateDefensive Driving Course DateDrives Which Car? Do you want to talk to your insurance advisor?*YesNo Any special concerns or questions to be answered? Δ
