Add and or remove vehicle Add a Vehicle This form will allow you to add a vehicle to your auto insurance policy. When you fill out this form, the information will be sent to an agent at Ullrich Insurance. We will let you know when we have an update. Keep in mind that no changes of your insurance policy are completed until you have received confirmation from us that it is completed. This is very important for you to know. Call us anytime if you have any questions about this.Name of client First and Last name.HiddenYour Name First and Last name. Your best email address Your best phone number Vehicle InformationYear Make Model VIN Date of purchase (mm/dd/yyyy) Price of vehicle (USD) Is it leased? Yes No Is it financed? Yes No Name of auto finance company Address of auto finance company Do You Currently Have Either Loan or Gap Coverage Yes No Would You Be Interested in Loan/Gap Coverage Yes No Is there any custom equipment?If you want coverage for any custom equipment added to the vehicle after it was manufactured, we need to know what equipment was added and the value of it.Whose names are on the registration? Which state will the vehicle be registered? AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Who will drive the vehicle? First and Last name. Is it driven to work? Yes No Do you own a business and do you drive it for your business? Yes No How exactly do you use the vehicle? Is there any signage on vehicle? Yes No What information is on the sign, where is it located, and how large is it? How many miles one way to work?How many miles will be driven annually? Will this vehicle be garaged at your home? Yes No Where will the vehicle be garaged? Do you have a vehicle you would like to remove from your policy? Yes No Vehicle RemovalWhich vehicle? What are you doing with the vehicle? At what date must the vehicle be removed MM slash DD slash YYYY NOTE: We do not remove a vehicle from an auto insurance policy until it is officially gone. For example, if you plan on selling the vehicle, we will not remove the vehicle until we have confirmed that the vehicle is sold. This ensures that a vehicle will not be left uninsured.
