PROPERTY POLICY CHANGE REQUEST

Please use the form below to notify us of any changes to your automobile policy insured through Rekerdres Insurance Agency. Please note that this form is for notification purposes and any changes will not be binding until you receive confirmation from our agency.
DISCLAIMER

I understand that my coverage (or changes in coverage) ARE NOT binding via this online request. Changes ARE considered binding when I receive an email (or fax) response from my agent indicating that they have received my request.

I have read and agree with the above disclaimer

POLICY HOLDER INFORMATION
Name Insured:
Phone Number :
Email:
Effective Date of Change:
PLEASE CHECK NATURE OF CHANGE:
Mortgagee Change
Increase/Decrease Limit of Insurance
Change of mailing address and/or phone number
Add/Delete from schedule
Add endorsement
Other
PLEASE DESCRIBE SPECIFICS OF YOUR REQUEST:

Click "submit" to send

 

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last updated 3-may-03