How can we help you? Which Policy Do You Need To Service?(Required) Auto Policy Home Policy Business Policy Other This field is hidden when viewing the formDate SubmittedWhat Other Type of Insurance?(Required)What type of change do you need to make?(Required) Please Select The Home Changes You Need To Make(Required) Change Mortgage Company Add More Personal Property Coveage Change Your Mailing Address Other New Mortgage Company Street Address Loan Number City 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 ZIP Code Mortgagee ClauseISAOAATIMABOTH Please Specify The Items Needing Coverage And Their Individual ValuesDo you have an appraisal or bill of sale for this dated within the last 3 years? Date MovedMonth(Required)Please enter a number from 0 to 12.Day(Required)Please enter a number from 1 to 31.Year(Required)Please enter a number from 1900 to 2030.Is there any connection to the old property that was insured?New Mailing Address Street Address Address Line 2 City 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 ZIP Code Please Specify Your "Other" Changes. Be As Specific As Possible Please Select The Changes You Need To Make(Required) Add Or Replace A Car Remove A Car Add A Driver Remove A Driver Add A Lienholder Change Your Mailing Address Other First Name(Required)Last Name(Required) Which Car Are You Removing? (Yr, Make, Model) Reason For Removal? Sold Other When Did You Get Rid Of The Car? (Specific Date) New Driver Full Name New Driver Date of BirthBirth Month(Required)Please enter a number from 1 to 12.Birth Day(Required)Please enter a number from 1 to 31.Birth Month(Required)Please enter a number from 1910 to 2030. New Driver DL#New Driver DL State New Driver Relation To You New Driver's Employer or SchoolNew Driver's Occupation Current High School Student / College Student With A 3.0 or Better GPA? Yes No If the new driver is a high school student with a 3.0 or better GPA, they may qualify for a "good student discount". You will need to submit proof (last report card).What type of vehicle do you drive?How many annual miles driven? Name Of Driver You Are Removing?Reason for RemovalIs This Person Still A Household Resident? Yes No Lender NameAddress Street Address Address Line 2 City 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 ZIP Code Which Vehicle Is This For? Date MovedMonth(Required)Please enter a number from 1 to 12.Day(Required)Please enter a number from 1 to 31.Year(Required)Please enter a number from 1900 to 2030.Is this a new address where your vehicle(s) will primarily live?New Mailing Address Street Address Address Line 2 City 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 ZIP Code Please Specify Your "Other" Changes. Be As Specific As Possible Is This New Car Replacing Another Car? Yes (Replace A Current Car With A Different Car) No (This Is a New Car To Me) I do NOT need to remove any vehicles from my policy Which Car Are You Removing?Please include Year, Make and Model How Will The New Car Be Used? Pleasure Work/School Commute Business/Commercial (Including Uber and Lyft) How Many Miles Will This Car Be Driven Annually?The average commuter will drive approximately 13,000 miles a year. Year / Make / Model - New VehicleWhat Is The 17 Character VIN# Of Your New Car?Please double check your entry to make sure it's correct. Also note VINs never contain the letters L or O (if you see them they are 1 or 0). What is the Purchase Date?Month(Required)Please enter a number from 1 to 12.Day(Required)Please enter a number from 1 to 31.Year(Required)Please enter a number from 1900 to 2030. Does Your New Car Need comprehensive and collision? Yes No What Comprehensive Deductible Would You Like? $100 $250 $500 $1000 Comprehensive claims cover damage to your vehicle that occurs typically while your vehicle is not in motion. At-Fault Accidents and Accidents with Uninsured Motorist do NOT fall under this. What Collision Deductible Would You Like? $100 $250 $500 $1000 NOTE: The lower the deductible, the higher the premium. Is there a lien holder (or do you own the vehicle outright?) If so, who?If none, enter "none"Lien Holder Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Who Is The Primary Driver? Business Policy(ies) Needing Service BOP Business Auto Business Liability Business Property Cyber Liability Workers Comp Other Other Type of Policy(Required)Please explain the details of your change reqeust.Please upload any files required to make the change.Max. file size: 5 MB. Mobile NumberWe Will Send A Text Confirmation That This Request Was Received Email(Required) Who is your Shoemaker Insurance Advisor(Required)Jonathan JewellKatie AlbartDane WilliamsI don't knowCAPTCHA
