Add a Driver or Household Member

I am a...

Only a named insured on the policy can request a policy change. If you are not a named insured, please call the office at 920-337-9345 for further instruction.

Client's Name

First NameLast Name

Your Name

First NameLast Name

Phone Number

Area CodePhone Number

Client's Email Address

example@example.com if no-email please type "mailhardcopy@iscinsurance.com"

Which insurance company are you with?

If you cannot remember, that is ok. Choose unknown.

What date should this driver be added.

Date

What type of driver are we adding?

Other

Umbrella Liability Policy: An umbrella liability policy is an additional policy you can purchase to go over the top of a large automobile bodily injury liability or homeowners liability claim. Please choose an option:

Full Name of Driver to Be Added

What is driver's relationship to you:

Residence of driver:

Other

College Student Details:
Full-time (12+ credits per term) or Part-Time:   *
Name of School:   Name of School*
Anticipated Graduation Year:   Anticipated graduation year*
Over or under 100 miles from home:   *
With or without vehicle:   *
Living arrangement:   *
Are you interested in a renter's insurance quote for your student?   *
Are you interested in life insurance for your student (consider student loans):   *

It is very important to keep ISC informed of your student's situation. The coverage varies based on the details above. For example, a part-time student living in an apartment might does not have the same coverage as a full-time student living in a dorm.   *

Custody Arrangement Details:
Living Arrangements:   *
Vehicle Information:   *
Insurance Information:   *

You selected Other for Residence of Driver. Please provide additional details of living arrangement:

Do you want this driver added as a "NAMED INSURED" on the policy. This would be typical for spouses or domestic partners only. A named insured has full rights under the policy and can make changes and/or cancel the policy. Any claim checks are typically made out to all named insureds.

What is the driver's occupation and name of employer

Example: Plumber at ABC Plumbing

Driver's Length of Time with Employer

10 years

Date of Birth of Driver

Driver's License #

What is the name of driver's insurance company?

Example: Progressive, Geico, American Family

Date Driver Obtained License (if over 3 years, you can list approximate year)

Vehicle Assignment

Rows	Please Type Name of All Drivers in Household	Primary Vehicle Driven (can list same vehicle as often as needed)	Primary Use	Miles one way (if commute was chosen)	Annual miles (if business or farm use was chosen)
Driver 1
Driver 2
Driver 3
Driver 4
Driver 5
Driver 6

For students: Does Driver Qualify for Good Student Discount (Full-time student with 3.0 or higher GPA)

Click here to attach a copy of most recent report card. If you cannot attach the report card, you can e-mail it to: iscmail@iscinsurance.com or mail a hard copy to our office at: ISC 436 Main Ave, De Pere, WI 54115

Browse Files

How would you prefer to be contacted if we have additional questions?

Other

Comments: Please provide any specific instructions, questions or concerns.

Insurance Companies Require that All Drivers in the Household or anyone with REGULAR access to your vehicles be listed on your policy.

(Note - if you are simply listing a roommate or family member who lives with you, but has their own insurance, the charge to add them is typically very low or nothing).

Are there additional drivers you need to add?

Will ANY drivers in your household be driving for hire such as snowplowing, delivering food, mail, packages, or driving for programs such as Uber, Lyft, Grub Hub, Eat Street or similar?

Will ANY drivers in your household be participating in hazardous activities such as racing, demolition derbies, or similar?

Life Insurance - Would you like to see prices for life insurance?

Western National Clients: Is driver in the military?

Western National Clients: Does driver have any bankruptcy/judgement or liens against them?

Mandatory for Progressive Clients: Has the driver had any traffic violations in the past 5 years, or any accidents/claims in the past 7 years (regardless of fault)?

Signature (On laptop/PC use your mouse. On a mobile device use stylus or finger.

ISC Staff: Your e-mail address for confirmation

example@example.com

ISC Staff: Name of person you spoke with

A copy of this form will be sent to:

-{clientsEmail}

-{iscStaff65}

-service@iscinsurance.com

Add a Driver or Household Member

---------For Office Use Only--------