Add/Remove Vehicle to Auto Policy - Mack Risk Management

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

Primary driver of vehicle*

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

Coverage Options*

Comprehensive Deductible:

Collision Deductible:

Towing

Rental

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 Vehicle - Vehicle Information

Effective Date of Change*

Vehicle 1 Year Model*

Vehicle 1 Make*

Vehicle 1 Model*

Vehicle VIN#

Reason for removing vehicle*

ADD OR REMOVE VEHICLE TO EXISTING POLICY

Policy Holder Information

Add a Vehicle - Vehicle Information

Remove a Vehicle - Vehicle Information

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