New Car Questionnaire

New Car Questionnaire

Please answer the following questions to help us update your auto policy accurately
Name

First NameLast Name
Email
example@example.com
Purchase Date / Lease Date

MonthDayYear
The first day that you need to start insuring the new vehicle
Year / Make / Model
Vehicle Identification Number (VIN #)
Cost of New Vehicle (with tags, title, etc.)
Please do not include (or subtract) the value of a vehicle trade in as part of the new cost. We need to know the full cost of the new car for replacement purposes. Certain insurance carriers offer an "Agreed Value" which is why this is important. Note: Not available with all insurance carriers.
What state (DC/MD/VA) will the vehicle be registered in and what zip code where the car be parked at night?
Does the vehicle have Custom or Additional Equipment to be insured?
How many miles are on the new car?
Approximate odometer reading is fine if you don't have the exact number.
How is the new vehicle being titled? Who's name is on the title of the vehicle?
For example, what name is on the title? Personal name/Business name/Joint husband and wife, LLC, Trust, kids on title, etc.

Driver Information
Who will be the PRIMARY operator of this vehicle?
All drivers typically have permission to use the vehicle (unless they are excluded) but a certain driver needs to be rated to each vehicle.
Do we need to add a new driver to the policy?

Coverage
Are you interested in "Full Coverage" which typically means Comprehensive and Collision?
"Full coverage" is required if this is a loan or lease. We will use the same deductibles that you have on the other vehicles on your policy unless you specifically tell us otherwise.
Are there any other specific coverages that you would like added?
New Car Replacement, Rental Reimbursement, Roadside Assistance, Loan/Lease Gap Coverage

Financing Information
Is there a loan on the vehicle? If so, what bank is providing the financing (Bank Name & P.O. Box)?
Is there a lease on the new vehicle? If so, what bank is providing the financing (Bank Name & P.O. Box)?

MVA/DMV Requirements For Prior Vehicle
Is this vehicle a new/additional vehicle or replacing an existing vehicle on your policy?
Which car needs to be removed from the policy?
What happened to the other car?

Other
Were the license plates of the previous car transferred to the new car?
Please note that we cannot remove the coverage on the old vehicle unless you have transferred the tags to the new car or you have returned them to the MVA.

DC:

http://dmv.dc.gov/node/1118886

MD:

https://mva.maryland.gov/Pages/license-plate-return.aspx

VA:

https://www.dmv.virginia.gov/vehicles/license-plates/surrender
Any other information that we should know or you want to discuss before submitting?
Who sent this form to you so that we can get it to right person? (Ashley / Judi / Ryan / Whitney / Claire)
Should be Empty:

Driver Information