Auto Change Information Form

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Auto dealer, 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. 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.

Auto Change Information Form

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.

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

Auto Change Information Form - Portrait of a Smiling Car Dealership Sales Agent Showing Her Two Clients the Contract for Their New Car Purchase