Leland Smith Insurance Services for Residential and Business. Insuring your home, auto, health and business.  
   
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Policy Changes > Auto > Add/Remove Vehicle

 Existing Clients
Add or Remove a Vehicle
Please carefully fill out and submit the form on the left. Your information will be submitted to our office and processed as quickly as possible.
Effective Date:
Policy Number:
Primary Policyholder's Name:
Insurance Company
Type of Change:
Year:
Make:
Model:
VIN:
Primary Use:
Anti-Lock Brakes:
Air Bags:
Anti-Theft:
Lienholder:
(Bank Name and Address)
Coverages:
Liability Limits:
Medical Payments:
Uninsured Motorists:
Comprehensive Deductible:
Collision Deductible:
Towing
Rental
   

If there is also a new driver that needs to be insured, You will also need to complete the Add Driver Form after this form is submitted

 
(Please verify all fields have been properly completed)

We appreciate your business and hope that you find our online resources useful. If you have questions, please feel free to Contact Us.
Independent Insurance Agent Leland Smith Insurance Services
1175 Westwood Dr. Suite 200
Van Wert, OH 45891-2464		 Trusted Choice -- We serve you first.

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Leland Smith Insurance Services, Inc., is licensed to conduct business in the States of Indiana and Ohio. The information on this site is a solicitation to conduct business in the aforementioned states of authority.