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Home > Customer Service > Vehicle Addition/Change/Deletion Request Form

Vehicle Addition/Change/Deletion Request

(* Required Field)

Name:

Disclaimer: No insurance coverage or policy change will take effect until a Hoffman Group associate advises you by phone or through written communication that coverage has been placed. If you need immediate service, please call us at (800) 826-4006.

Policy Number:

Phone:

E-mail:

Date of Change:

Vehicles

Year:

Make:

Model:

Vehicle ID #:

Car is leased?

Loss Payee/Additional Insured Information

Please include the name and address of the lien holder

I would like the following coverages:

Please remove the following vehicle from my policy:

Year:

Make:

Model:

Vehicle ID #:

Coverages

Please change the coverages on my policy as shown below.
This request applies to the following car(s)

2 Berea Commons, Suite 10 Berea, Ohio 44017	5329 N. Abbe Road Suite 4A Elyria, Ohio 44035	5000 Foote Road Medina, Ohio 44256
	1.800.826.4006