ADD OR REMOVE VEHICLE TO EXISTING POLICY

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

    Policy Holder Information

    Name*

    Business Name

    Street*

    City*

    Zip / Postal Code*

    Phone Number*

    E-Mail Address*

    Add a Vehicle - Vehicle Information

    Effective Date of Change*

    Year*

    Make*

    Model

    Vehicle VIN#*

    Does Vehicle have Loan or Lease*

    Bank/Finance or Lease Information

    Name on Vehicle Title*

    Primary driver of vehicle*

    How many miles to you drive one way to work? (Approximately)

    Coverage Options*

    Comprehensive Deductible:

    Collision Deductible:

    Towing

    Rental

    Remove a Vehicle - Vehicle Information

    Effective Date of Change*

    Vehicle 1 Year Model*

    Vehicle 1 Make*

    Vehicle 1 Model*

    Vehicle VIN#

    Reason for removing vehicle*

    DISCLAIMER: Any changes/requests/quotes expressed over the internet can only be honored after River's Edge Insurance Agency has acknowledged the receipt of the change and after underwriting approval. Changes expressed in emails or messages are not bound automatically. All new policies and changes are subject to verification and underwriting approval. Customer Service hours at River's Edge Insurance Agency are Monday-Friday 8:00 AM – 4:30 PM.