Automobile Change Request

Call (248) 651-7321 8:30 a.m. to 5:00 p.m. EST to speak to a member of our licensed & accredited staff.

 

Please email us at whimsins@whimsinsurance.com or complete the form below:

 

To help us serve you better, please complete all required information (indicated by an asterisk*)

Policy Holder's Information
* Insured Name:
* Principle Driver:
Usage:
Title Holder:
Policy Information
* Effective Date:
Delete Vehicle?
Yes
if yes, which vehicle?:  
Last 5 Digits of Deleted Vehicle VIN:  

Add Vehicle :
* VIN #:
Cost New :
*cost is required for future year vehicles
Same      Coverage?
  Yes  No     
 If changes required, list items below:
New Vehicle Safety and Theft Deterrent Devices:
Please check all that apply:
Dual Airbags          Side Air Bags             ABS Brakes
Keyless Entry     Alarms - Factory Installed non-factory
 Non-Factory Installed Equipment   Est. Value  
Description:
Aquisition Information :
  Financing Choice:
Lease     
Purchase     
Lease/Lienholder Information:
Dealership Information :
Dealership Name:
Sales Person:
Phone:
Fax:

Form Submission Agreement:
I agree that by submitting this form the questions were answered to the best of my ability.
I am authorizing Whims Insurance to act upon the information given. 

Please check if you agree to these terms: 

If you entered a valid email address, you will receive a computer generated confirmation that the form has been sent.  We will personally send you an email confirmation once we have received and evaluated your request.

  

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