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Add and Remove a Vehicle Form

Request Effective Date *

Owner's First Name *

Owner's Last Name *

Insurance Company Name *

Policy Number *

Email Address *

Phone *

Address ( Please provide only if policy number not available.) *

City *

State *

Postal code *

Vehicle to Add

Vin Number *

Vehicle Year 1 *

Vehicle Make 1 *

Vehicle Model 1 *

Purchased Date / Effective Date *

Desired Coverage *

Do you use your vehicle for ridesharing services? *

Do you want to add an additional driver? *

Vehicle to Remove

Copy of temporary registration or Bill of sale / If used vehicle, requires full coverage, provide pictures of 4 sides of vehicle, if possible. *

Vin Number 2 *

Vehicle Year 2 *

Vehicle Make 2 *

Vehicle Model 2 *

Did you return your license plate (tag) to MVA / DMV? *

Yes

No

Disclaimer: We strongly recommend submitting this request only after you have returned your license plates/tags to the MVA/DMV, as applicable, to help avoid potential penalties or other consequences. By submitting this form, you acknowledge that you have read and understand this disclaimer and are aware that Ensurancemax assumes no responsibility or liability for any penalties, fees, fines, or other consequences that may result from submitting this request before returning your tags to the MVA/DMV.

MVA Return Tag Receipt *

Message *

Please select your agent / Representative if applicable *

Are you the named insured on this policy? *

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