McKay Insurance Service Request Form

McKay Insurance Service Request Form

Use this form to request help with an existing policy. Online requests are reviewed during business hours and are not immediate.
Client Information
What's your name?

First NameLast Name
What's your phone number?
Format: (000) 000-0000.
What's the best email to contact you?
Preferred contact method
Policy Information
What type of policy is this request for?

Other
Insurance carrier, if known
Policy number, if known
Request Type
What do you need help with?
Policy Changes
What type of policy change are you requesting?
When would you like this change to take effect?

MonthDayYear
Some changes cannot be backdated or completed immediately. We will confirm what is possible after reviewing your request.
Please provide the details of your request
Document Request
What documents do you need?
How should we send the document?
If the document should be sent to someone else, please provide their name and contact information
When do you need this by?

MonthDayYear
Date
Billing Inquiry
What kind of billing help do you need?
Please describe your billing issue or question
Tell us what notice or bill you received, the amount due if known, the due date, and what you need help understanding.
Cancellation Request
Requested cancellation date

MonthDayYear
Date
Reason for cancellation

Other reason
Upload proof of replacement coverage, bill of sale, plate return, or other supporting documents, if available.

Submitting this form does not cancel your policy. Cancellation requests must be reviewed and may require signed authorization, proof of replacement coverage, carrier approval, or additional information before they can be processed.
Cancelof
Claims Help
What type of claim is this?

Other
Date of loss

MonthDayYear
Date
Has the claim already been reported to the insurance carrier?
Please briefly describe what happened.
Include what happened, where it happened, whether anyone was injured, and whether the property or vehicle is still safe to use.
General Question / Other
What do you need help with?
Please provide as much detail as you can so we can route your request properly.
Uploads
Upload any supporting documents, photos, bills, notices, or forms

You can upload bills, cancellation notices, declarations pages, claim documents, photos, lender requests, or anything else related to your request.
Cancelof
Final Acknowledgement
I understand that submitting this form does not guarantee that coverage has been changed, added, cancelled, reinstated, or bound. My request is not complete until confirmed by McKay Insurance or the insurance carrier. I understand that online requests are reviewed during business hours and urgent requests should be handled by calling the office directly.
Should be Empty:

McKay Insurance Service Request Form

Client Information

Policy Information

Request Type

Policy Changes

Document Request

Billing Inquiry

Cancellation Request

Claims Help

General Question / Other

Uploads

Final Acknowledgement