Add a Vehicle to your policy is a type of Policy Change form from Keyes Insurance Brokerage, where you can add a new vehicle to your existing insurance policy. Add a Vehicle Name of 1st insured:*Name of 2nd insured:How can we reach you?* Phone Email Phone*Email* New VehicleVehicle make*Year*Model*Condition at time of purchase*NewDemoUsedPurchase date* MM slash DD slash YYYY Purchase priceVIN (vehicle ID #)Any non-factory modifications to the vehicle?* Yes No Any unrepaired damage?* Yes No If yes, specifyName of registrantUse of vehicle*PleasureCommutingBusinessFarmingOtherDetails if use is otherKilometres traveled per year:*0-50005001-1000010001-1500015001-2000020001-3000030001+How many kilometers one-way for daily commute?*NA0-56-89-1617-2425+Will replacing this vehicle result in changes in use of other vehicles owned?* Yes No Third party Liability coverage requested*$1,000,000$2,000,000Collision coverage and deductible requested* No Coverage Yes - deductible (min) $500 $1000 Comprehensive coverage and deductible requested* No Coverage Yes - deductible (min) $300 $500 All perils coverage and deductible requested* No Coverage Yes - deductible (min) $500 $1000 Driver Information(for all drivers who will be operating this vehicle)Driver*Date of birth* MM slash DD slash YYYY Driver type #1* Principal Occasional DriverDate of birth MM slash DD slash YYYY Driver type #2 Principal Occasional DriverDate of birth MM slash DD slash YYYY Driver type #3 Principal Occasional Effective DateWhen will this change be effective?* MM slash DD slash YYYY About Your InsuranceCompany*Policy #*Name of your brokerAdditional Comments
