Commercial Auto Change Request

Coverage change requests are not effective until written confirmation is received from the carrier.

Please note: a separate request will need to be submitted for each change to coverage.

Desired Effective Date of the Requested Change *

Vehicle Year

Vehicle Make

Vehicle Model

Vehicle VIN

Description of Vehicle Body Type (Example: Cargo Van, Flatbed, Pickup, SUV.)

Gross Vehicle Weight

Any person or business entity operating a commercial vehicle with a Gross Vehicle Weight of 10,001 pounds or more is required to carry a Motor Carrier Permit (MCP).

Current vehicle value including any permanently attached equipment or vehicle conversions

Does the vehicle have any of the following?

Does this vehicle have a converted bed? (example: Flat bed, Cargo bed, Stake bed)

Yes

Description of the Converted Bed

Cost of the Conversion

Is there any equipment permanently attached to the vehicle (example: ladder rack, tool box, etc)?

Yes

Description of Equipment

Value of Equipment

Equipment not permanently attached may be insured separately via an Inland Marine Insurance policy. This may include construction tools and equipment. Please contact your agent for more information.

Garaging address (address where vehicle is parked overnight):

Address

City

State

Zip Code

Vehicle Use

Business and Personal Use

Business Use Only

Personal Use Only

Radius of Operation (Miles):

Average Number of Jobsite Visits Per Day Using this Vehicle

0-1

Is there a lien holder for this vehicle?

Yes

Lien Holder Name

Lien Holder Address

Lien Holder City

Lien Holder State

Lien Holder Zip Code

Do you require Gap Insurance? (Not available with all insurance carriers.)

Yes

Gap insurance is an optional coverage that can be added to your policy which may pay the difference between the balance owed on a lease or loan and what your insurance company pays if the vehicle is considered a total covered loss.

Vehicle Coverage

Do you want Comprehensive and/or Collision Coverage for this vehicle? (Hunter Insurance Services recommends you add these coverages.)

Yes

Comprehensive Deductible

Collision Deductible

Do you want Rental Reimbursement Coverage? (Only available with Comprehensive and Collision added.)

Yes

Rental reimbursement "rental car coverage" is a type of optional coverage that helps pay for the cost of a rental car while your vehicle is being repaired after a car accident or after suffering damages that are covered through your policy. Not for pleasure use.

Desired Daily Reimbursement (30 Day Maximum)

Do you want Towing Coverage?

Yes

Towing Coverage only available with Comprehensive and Collision added. Towing Coverage pays for the cost of towing your car to the nearest repair shop when it is unable to be driven after a car accident and covers a specified amount of necessary labor charges at the place of breakdown.

Trailer Year

Trailer Make

Trailer Model

Trailer VIN

Description of Trailer Body Type (Example: Flatbed, Dump Trailer, Semi-Trailer, etc.)

Load Capacity

Trailer (Greater than 2,000 lbs.)

Service or Utility Trailer (Less than or equal to 2,000 lbs.)

Shop Made Trailer (Less than or equal to 2,000 lbs.)

Shop Made Trailer (Greater than 2,000 lbs.)

Value of Trailer

Cost of Trailer New?

Do you want Comprehensive and/or Collision Coverage for this trailer? (Hunter Insurance Services recommends you add these coverages.)

Yes

Collision Deductible

Comprehensive Deductible

Remove Vehicle or Trailer

Year

Vehicle/Trailer Make

Vehicle/Trailer Model

Vehicle/Trailer VIN

Reason you would like to remove the vehicle or trailer from the policy?

Date of Birth

Gender

Male

Female

Driver's License Number

Issuing State

Marital Status

Number of years driving experience?

Relationship to the Insured?

Full Name of Driver to Remove

Reason you would like to remove this person from coverage on the policy?

Authorization

By clicking on the "submit" button below I acknowledge that I am an authorized representative/signer of the entity listed above and I am authorized to make changes on the insurance policies purchased through Hunter Insurance Services.

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