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907-373-5239

907-373-5239

  • Home
  • Business
    • (BOP) Business Owners Insurance
    • Business Insurance
    • Bonds
  • Personal
    • Auto Insurance
    • Home Insurance
    • Renters Insurance
    • Motorcycle Insurance
    • Boat Insurance
    • ATV Insurance
    • Motorhome Insurance
    • Life Insurance
    • Annuities
  • Planning
    • Life Planning
    • Retirement Planning
  • Quote
    • Auto Quote
    • Auto Policy Change
    • Builders Risk Quote
    • Business Quote
    • Certificate of Insurance
    • Home Quote
    • Recreational Vehicle Quote
  • Info
    • Insurance Documents
    • Meet Our Team
    • Community
  • Payment Center

Auto Policy Change Form

Attention!

Submitting this change form does not bind or alter coverage, you must speak to a licensed agent to confirm coverage changes.
Name
Add Vehicle
Year
Make
Model
VIN#
Liability Cov. $
Comprehensive Cov. $
Collision Cov. $
Lienholder
Eff. Date.
 
Remove Vehicle
Year
Make
Model
VIN#
Eff. Date of Removal
 
Add Driver
Name
DOB
AK DL#
SSN#
Married
Gender
SR-22
Eff. Date to Add
 
Remove Driver
Name
DOB
AK DL#
SSN#
Eff. Date to Remove
 
Violations/Accidents
Driver Name
Date of Acc./Viol.
Type of Acc./Viol.(Speeding Ticket, At Fault Acc.)
 
I Agree(Required)
Consent(Required)
Most of the information we obtain comes directly from you. Your application gives us the information we need to review your requests, such as your name, address, Date of Birth, and Social Security Number. It is our policy to treat information we receive about you in the same confidential way we treat information that you have provided to us on your application. The same confidentiality applies to information about our former customers. We only disclose personal information about you as permitted by law. Generally, this includes sharing it with third parties to administer your transactions with us, service your insurance policy or claim, detect and prevent fraud, or with your authorization. We require these parties to use your personal data only for the reasons we gave it to them.

Barrett & Associates

907-373-5239

907-373-5248

962 N Meridian Pl

Wasilla, AK 99654

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