Add Vehicle

Policyholder Information

Please provide the policyholder's information

Business Name *

Phone Number *

Email Address *

Save and Resume Later

Vehicle Information

When would you like this change to take effect?

Desired Effective Date: *

Today
Future Date

Desired Effective Date: *

Please enter your policy number.

Policy Number *

Please select from one of the following:

Provide Vehicle's Info by *

Upload Vehicle Registration
Input Vehicle Information

Upload Documents *

Click or drag files to this area to upload. You can upload up to 5 files.

Vehicle Category *

VIN Number *

Please enter the 17-digit vehicle identification number (VIN) assigned by the vehicle manufacturer.

Vehicle Year *

Vehicle Make *

Vehicle Model *

Vehicle Body Type *

Is the vehicle equipped with an anti-theft or telematics device?

Equipped Vehicle Device *

Anti-Theft Device
Telematics Device

Active Anti-Theft Device: This device requires the driver to activate it using a button or remote to arm the system.
Passive Anti-Theft Device: These devices automatically engage when the vehicle is turned off, or the key is removed from the ignition. No driver activation is required.
Tracking Device: This device uses GPS technology to track and locate the vehicle if stolen. It typically requires a monthly or annual subscription fee for the tracking service.

A vehicle-installed system records driving habits like mileage, speed, and brake response.

Anti-Theft Device Type *

Does the vehicle have any of the following equipment or accessories?

Vehicle Equipment/Accessories *

None
Ball at Bumper
Ball in Bed
Fifth Wheel
Gooseneck
Tow Boom

What is the vehicle's current value?

Vehicle Current Value *

Is there any non-factory equipment or conversions added to the vehicle?

Non-Factory Equipment/Conversions? *

What is the non-factory equipment or conversions value?

Non-Factory Equipment/Conversions Value *

Vehicle Location and Usage

Garaging Zip Code *

Vehicle Use *

Vehicle Annual Mileage *

What is the average number of jobsite visits or errands per day?

Average Jobsite Visits/Errands *

0-1
2
3
4 or More

What is the mile radius of your business operations?

Mile Radius of Business Operations *

Up to 100
Up to 200
Up to 300
Up to 400
Up to 500
Over 500

Is the vehicle used for deliveries or to pick up goods?

Vehicle Used for Deliveries/Pick-Ups? *

Please select the vehicle ownership type.

Vehicle Ownership Type *

Do we need to add a lienholder to your policy?

Add Lienholder? *

Please provide the lienholder’s information.

Lienholder’s Name *

Lienholder’s Address

Street Address *

Address Line 1

Address Line 2

City

State

Zip Code

Are you required to carry gap insurance? (not available in all states)

Gap Insurance? *

Would you like comprehensive and collision coverage for this vehicle? (recommended)

Comprehensive and Collision Coverage? *

Please select the desired deductible.

Comprehensive *

Collision *

Would you like rental reimbursement coverage for this vehicle?

Rental Reimbursement Coverage? *

Please select the desired coverage.

Rental Reimbursement *

Would you like towing coverage for this vehicle?

Towing Coverage? *

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Final Review

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This is a preview of your submission. It has not been submitted yet!
Please take a moment to review your submission to ensure its accuracy. You can also go back to make changes.

Terms and Conditions *

I agree to the below terms and conditions: *

By submitting this policy change request, I declare that I am a duly authorized representative and/or signatory of the entity specified above and possess the requisite authority to effectuate modifications to the insurance policies procured through Fairbanks Insurance Brokers Inc.

Important Note: This submission does not automatically modify coverage. The original terms and conditions of the policy will remain unchanged until the carrier has reviewed, approved, and issued a formal endorsement. We strongly advise that you only assume modifications are in effect once official documents are received.

Authorized Representative

First Name *

Last Name *

Phone Number *

Email Address *

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Add Vehicle

Policyholder Information

Please provide the policyholder's information

Vehicle Information

When would you like this change to take effect?

Please enter your policy number.

Please select from one of the following:

Is the vehicle equipped with an anti-theft or telematics device?

Does the vehicle have any of the following equipment or accessories?

What is the vehicle's current value?

Is there any non-factory equipment or conversions added to the vehicle?

What is the non-factory equipment or conversions value?

Vehicle Location and Usage

What is the average number of jobsite visits or errands per day?

What is the mile radius of your business operations?

Is the vehicle used for deliveries or to pick up goods?

Please select the vehicle ownership type.

Do we need to add a lienholder to your policy?

Please provide the lienholder’s information.

Lienholder’s Address

Are you required to carry gap insurance? (not available in all states)

Would you like comprehensive and collision coverage for this vehicle? (recommended)

Please select the desired deductible.

Would you like rental reimbursement coverage for this vehicle?

Please select the desired coverage.

Would you like towing coverage for this vehicle?

Final Review

Authorized Representative