Complete this form to add or replace a new vehicle on your existing policy Client Name First Last Phone NumberEmail Are you adding or replacing a car?* Adding Replacing VIN # of new car17 digits Year / Make / ModelPlease list the year, make and model of new carYearMakeModelYear / Make / ModelPlease list the year, make and model of car you are replacingYearMakeModelAre you requesting same coverage as your current full coverage vehicle? Yes No Purchase Price of New Vehicle Do you have financing? Yes No Is it a lease? Yes No Who is the financing with?NameAddressDo you need Gap Insurance?If the loan amount is worth more than the value of the new car Yes No Contact Number for DealershipEffective Date MM slash DD slash YYYY Once coverage is in place you will get copies of new ID cards and update billing in the mail within 7 business days.