(* Required Field) Name: * Disclaimer: No insurance coverage or policy change will take effect until a Hoffman Group associate advises you by phone or through written communication that coverage has been placed. If you need immediate service, please call us at (800) 826-4006. Policy Number: Phone: * E-mail: *     Date of Change:     Vehicles   Year: Make: Model: Vehicle ID #:       Car is leased? Y/N Yes No Loss Payee/Additional Insured Information Please include the name and address of the lien holder I would like the following coverages:   Please remove the following vehicle from my policy: Year:   Make:   Model:   Vehicle ID #:     Coverages Please change the coverages on my policy as shown below. This request applies to the following car(s) Disclaimer: No insurance coverage or policy change will take effect until a Hoffman Group associate advises you by phone or through written communication that coverage has been placed. If you need immediate service, please call us at (800) 826-4006.         Either call us or submit a request for an insurance quote online.  We will work to meet your insurance and risk management needs in a timely and cost-effective manner.

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