Change: Add Vehicle - Inside Insurance

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Change: Add VehicleMatthias Allred2025-02-13T09:52:40-07:00

Policy Change: Add Vehicle

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Vehicle Details

Was this vehicle purchased Brand New or Used?*

Brand New

Used

Purchase Date*

MM slash DD slash YYYY

Year*

Make*

Model / Trim level*

VIN*

Verify the VIN by using: VehicleHistory.com

Sticker Price*

Odometer Reading*

Who will the Vehicle be titled to?*

Does this vehicle have any existing damage?*

No

Yes

List existing damage*

Does this vehicle have Branded or Salvage Title?*

No

Yes

Is there a Loan or Lease on the vehicle?*

Financed

Leased

No, Paid Cash

Upload Vehicle Documentation

Drop files here or

Accepted file types: pdf, jpg, jpeg, jpg, png, gif, Max. file size: 12 MB, Max. files: 5.

Comments or Notes

Financing Information

Finance Company Name*

Leasing Company Name*

Address

Street Address Address Line 2 City State Zip Code

Would you like GAP coverage if available?*

Yes I do

Let me know how much first.

No I do not.

Supporting Finance Documents

Drop files here or

Max. file size: 128 MB.

Vehicle Use

Do we need to Update household drivers?*

Yes, we need to add a driver

No new drivers in household

Driver Details

Date Driver to be Added*

MM slash DD slash YYYY

First Name of New Driver*

Last Name*

Does this person live at your address?*

Yes

No

What is their address?*

Street Address City State Zip Code

What is their relationship to you?*

Indicate Relationship*

Driver Information

Date of Birth

Month

Day

Year

Marital Status*

Gender*

Drivers License State*

Driver's License Number*

Social Security Number

Is the new driver a student?*

Yes

No

Student Information

Does he/she have a 3.0 GPA or higher?*

Yes

No

Do you want to upload report card(s) now?*

Yes

No, I'll send in later

Upload Report Card(s)*

Drop files here or

Accepted file types: jpg, jpg, jpeg, png, pdf, Max. file size: 12 MB, Max. files: 4.

Vehicle Use

Who will be the primary driver?*

How will the vehicle be used?*

Commute

Business

Pleasure (extra car)

How many miles do you commute one direction?*

Estimated Annual Miles driven?*

Is this Vehicle Used for Rideshare (Uber, Lyft, etc.)?*

No

Yes

Provide details about Rideshare usage*

Is this Vehicle Used for any kind of delivery (Newspaper, Pizza, etc)?*

No

Yes

Provide details about delivery usage*

Coverage Options

Comprehensive Deductible*

Collision Deductible*

Do you want Rental Car reimbursement coverage?*

Yes

No

Do you want Roadside Assistance Coverage?*

Yes

No

Do you want Full Glass Coverage (if available)*

Yes

No

Contact Info

First Name*

Last Name*

Cell Phone*

Email*

Consent*

Change Approval Required*

I understand that no changes will go into effect until an agent has reviewed the request to make sure it complies with my insurance company's underwriting guidelines and the change has been accepted by the company.

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Admin Use Only

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Form Category

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Form Name

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Agency Name

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AMS ID

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CRM ID

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Internal Use

Yes

Internal Use Only

Person completing this form*

Matthias

Todd

Laura

Jenniea

Method request was received*

Phone Call

Email

Text Message

Chat / Messenger

Ezlynx Notification

Facebook

Agent Generated

Other

Agent Email

Additional Notes / Instructions

Task Due Date

MM slash DD slash YYYY

Task Assignee

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Task Assignee Full Name

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Task Assignee AMS User ID

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Task Assignee Email

End

The insured is responsible for reviewing and confirming all insurance coverages, terms, and conditions.
While we strive to provide accurate and up-to-date information, coverage details, limits, and exclusions are subject to the terms and conditions of the issued policy.
It is the insured’s responsibility to verify that their policy meets their specific needs. Please consult your policy documents and speak with your insurance provider or broker for any clarifications.

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