Auto Change Information Form

Auto Dealers: Please submit the following information for our mutual clients to secure the proof of insurance for their new vehicle.  We will contact our insured to confirm coverage. Information marked with an asterisk (*) is required on this form and if the information requested does not apply just fill in “none” in that section. Proof of insurance will be emailed or faxed to you upon receipt of this form. We will then contact the insured to confirm coverage and endorse their policy.

Please Note: if the client does not currently have a policy with Harbor/Brenn Insurance, they need to call and secure a quote and policy before we can provide proof of insurance.