Colton, Downey & Associates, Inc.


	1122 Veterans Drive, Jacksonville, IL 62650 217-243-8484 FAX 217-243-3301 109 Morse, Roodhouse, IL 62082 217-589-5890 FAX 217-589-4925

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

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

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.

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:


	Click here to find the NADA value of your vehicle.

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