Auto Dealers New Auto Form

Dealers, please submit the following form with your client's new vehicle information

We will contact the insured/client to confirm before making any changes to the insurance policy

Date that vehicle was purchased: *

Client's name: *

Client's phone number: *

Name on title:

(if different)

Year: *

Make: *

Model: *

VIN #: *

Air bags: *

Anti-lock brakes: *

Anti-theft: *

Describe ownership of the vehicle: *

Was there a vehicle traded in: *

Dealer name: *

Phone number: *

Fax number: *

E-mail address: *

Dealer, proof of insurance will be emailed or faxed to you upon receipt of this form

We will then contact the insured to confirm coverages and add to their policy

Additional Information

Comments or additional information:

I accept the Terms and Conditions

Increased Security

Why can't things just stay the same? We ask ourselves this question all the time. In the "old" days, the car dealer simply called the local agent and told them to add a car. Today, agents aren't really even allowed to verify the customer's coverage without approval. We will be happy to make this change after we have received confirmation from our customer.

* Part of the purpose of Solutions is to help your agency identify areas of security that could create problems for both the agency and the customer. It also creates a competitive edge drawing people to you.

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Auto Dealers New Auto Form

Dealers, please submit the following form with your client's new vehicle information

Additional Information

Increased Security