Colton, Downey & Associates, Inc.


	1122 Veterans Drive, Jacksonville, IL 62650 217-243-8000 FAX 217-243-3301 109 Morse, Roodhouse, IL 62082 217-589-5890 FAX 217-589-4925

Get a Quote

Personal Insurance

Home, Auto, Boat, Mobilehome, Motorcycle, Rental Dwelling, and more.

Business Insurance

As Business Grows, and You Start To Have Insurance Woes, Call The Pros

Claim Services

24 Hour Claim Services

Auto Change Request Form:
Thank you for visiting our automobile change request page. Please complete the form as best you can. Please note: NO coverages are bound until you receive confirmation of the change.

All fields are required except for the last two checkboxes regarding additional information you would like to receive.

Effective Date of Change:
Name:
Address:
E-mail:
Policy Number:
Type of Change to Vehicle:	Add
	Replace
	Remove
If replacing, which vehicle should be replaced:
Year of Vehicle:
Make of Vehicle:
Model of Vehicle:
Vehicle Identification Number (VIN):
Loss Payee - Bank:
Bank Address:
Is the Vehicle Leased:	Y N
Driver of Vehicle:
Use of Vehicle:
"Other Than Collision" or Comprehensive Deductible:
Collision Deductible:

Thank you for completing this form. If you would like additional information on any of the other lines of insurance we offer, please check the appropriate box:
Homeowners Insurance:
Umbrella Insurance:

* Verify the characters in the image above by re-typing them here:

Return To Top