Member Services

Current Insured

Vehicle Change/Addition Form

As a current policy holder you may use our simple form below to report any new or pre-owned vehicle additions or deletions. The completion of this form does not bind or alter your coverage. A representative from Marsh USA, Inc. will contact you.

Firm Name:*

State:*

Vehicle Deletion

Effective Date:

Vehicle Year:

Make:

Model:

VIN Number:

Vehicle Addition

Date Effective:

Year:

Make:

Model:

VIN Number:

Cost:

Is vehicle titled in company name?

YesNo

If this vehicle is a truck, is there a topper toolbox or camper shell?

YesNo

Where will this vehicle be garaged?

Is this vehicle being leased?

YesNo

Is this vehicle being financed?

YesNo

If your vehicle is being leased or financed, please fill in the lender's contact information below.

Lender's Name:

Address:

Special Instructions

Requested By:

Date Requested:*

* Required

AR Ins. Lic. #245544
CA Ins. Lic. #0633005
d/b/a in CA Seabury & Smith Insurance Program Management