← Back to Forms Add / Delete Vehicle Form The below form is to be used when adding, changing, or deleting a vehicle from your fleet. Step 1 of 5 - Requestor 0% Requested ByRequestor Name(Required) First Last Requestor Email(Required) CoveragePlease be advised that the following vehicle should be(Required) Added Deleted Changed Description of Change(Required)Reason(Required)For deletions, please list reason (sold / traded / totaled, etc.) Attach Bill of Sale, if applicableAttach Bill of Sale, if applicable.Max. file size: 100 MB.Please select coverages desired(Required) Full Coverage (Liability, Comprehensive, and Collision) Liability Only If Applicable: Short Term Lease Long Term Lease Insured(Required)Effective Date(Required) MM slash DD slash YYYY Vehicle RegistrationName of Registered Owner(Required)Address of Registered Owner(If not named insured) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code State Registered(Required) AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Please provide vehicle registration.(Required)If not available, please provide the temporary registration.Max. file size: 100 MB. Year(Required)Make(Required)Model(Required)Vehicle Additional InformationInsured Unit #(Required)VIN(Required)* Most VIN's Contain 17 DigitsCost NewGaraging Location(Required) City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Radius of Operation(Required) Under 50 Miles 51 - 100 Miles 101 - 200 Miles 201 - 300 Miles 301 - 500 Miles Over 500 Miles Additional Interest, Documentation, & SignatureAdditional Interest (if applicable) Loss Payee Lender's Loss Payee Additional Insured Loss PayeeNameAddress Add RemoveLender's Loss PayeeNameAddress Add RemoveAdditional InsuredNameAddress Add RemoveUpload Additional DocumentationExample: Bill of sale, registration, etc. if not already provided. Drop files here or Select files Max. file size: 100 MB. Signature(Required)
