Add / Remove Driver Form

Add / Remove Driver form
Name of person requesting this change

First NameLast Name
Personal Auto or Commercial Auto policy?
Name of the business
Your Phone Number
Please enter a valid phone number.
Your Best Email Address
example@example.com
Your Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Add Driver information
Does this person live in your household?
Address where this driver resides

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date

MonthDayYear
Date
Is this driver a full time student?
If they have above a 3.0 GPA, please upload proof of most recent FULL semester grades showing their grades/GPA and some identifying information. OR use the option below to take a photo of that documentation

Cancelof
Take Photo
Add another driver?
Add Driver information
REMOVE Driver information
Address where this driver resides

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please verify that you are human*
I understand and have read the full disclosure below*
Remember, no coverages can be bound, changed, or cancelled until you get confirmation from a licensed agent of the McGinniss Himmel Insurance Agency, LLC. This form allows us to more accuratly and quickly help get you taken care of, but submission of this form does not bind, alter, or change your coverage. We OFTEN can respond to these within 4-6 business hours, but please allow us 24 hours (Monday-Friday) to review and contact you with options and confirmation of coverage.

Text Messaging information: By completing this form and interacting with our agency, you consent to receive SMS messages from McGinniss Himmel Insurance Agency LLC at (850) 329-6996 or (863) 607-4440 about Account Notifications, Customer Care, Delivery Notifications, and Marketing. Message frequency may vary, and standard messaging and data rates may apply. Reply STOP to unsubscribe or HELP for assistance. For more details, see our Terms and Conditions and Privacy Policy on https://www.insurancemh.com
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Add / Remove Driver form