Add or substitute a vehicle

Please call us if you need immediate service

Name of Policy Holder:
Address:
Address 2:
City/Town:
Postal Code:
Email Address:
Home Phone:
Work Phone:
Fax Number:
Which A.P. Reid Office normally
provides your policy service?:
Policy #:
Effective date of change
(mm-dd-yyyy):
 
Year/Make/Model of vehicle:
Date of purchase (mm-dd-yyyy):
Serial number:
Registered owner:
Primary driver:
Daily mileage to work/school
(one way, state whether MI or KM):
Annual mileage (state whether MI or KM):
Is this vehicle replacing
an existing one on the policy?
If yes identify original
vehicle to be removed:
How was the original vehicle
disposed of? (Sold, traded, etc)

Coverages

APREID INSURANCE STORES LIMITED will add the vehicle with the existing Bodily Injury, Property Damage, Medical Payments and Uninsured/Underinsured Motorists Coverages currently showing on your policy.

Optional Coverages like Collision, Comprehensive and Fire/theft will not be added unless the information below is completed. To discuss the various coverage options available to you, please call our office.

Comprehensive coverage :
Collision coverage:
Waiver of Depreciation
(only available on brand new vehicles):
Rental Reimbursement:
Loss Payee/Additional
Insured/Lien Holder's Name:
Loss Payee/Additional
Insured/Lien Holder's Name:
Loss Payee/Additional
Insured/Lien Holder's Name:
Loss Payee/Additional
Insured/Lien Holder's Name:
Is this vehicle leased?:


New Driver Information

If you need to add a new driver for this vehicle, please complete the following section. Otherwise, skip to the bottom of the page and click the “Send" button.

Drivers name (as it appears on drivers license):
Date of birth (mm-dd-yyyy):
Drivers license number:
Age first licensed:
Relationship to you:
Occupation:
Frequency of vehicle use:


Please note, this transaction is not effective until you receive a confirming call, email or the Policy Declarations page showing the change.