Columbia Office 720 S Main St.
Columbia, IL 62236

618-281-8887

ADD OR REMOVE A DRIVER TO AN 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*

    Street*

    City*

    State*

    Zip / Postal Code*

    Primary Phone Number*

    Alternate Phone Number

    E-Mail Address*

    Policy Number*

    Current Insurance Provider*

    Add a Driver - New Driver Information

    Name of Driver (First, Last)*

    Gender*

    Marital Status*

    When will this change take effect?*

    Relationship*

    Date of Birth*

    Does this driver have any major violations (5yrs), accidents or minor violations (3yrs), comprehensive or collision claims (3yrs)?

    DISCLAIMER: Any changes/requests/quotes expressed over the internet can only be honored after Mack Risk Management 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 Mack Risk Management Insurance Agency are Monday-Friday 8:30 AM – 5:00 PM.

    Remove a Driver - Driver Information

    Name of Driver (First, Last)

    When will this change take effect?

    DISCLAIMER: Any changes/requests/quotes expressed over the internet can only be honored after Mack Risk Management 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 Mack Risk Management Insurance Agency are Monday-Friday 8:30 AM – 5:00 PM.

    Resource Menu