Home or Farm Policy Change Request
Client Name
*
First Name
Last Name
Email
*
Policy Number
If unknown, you can leave blank
Do you need to update your address?
*
No
Yes
Updated Address:
*
Street Address
Mailing Address (if needed)
City
State / Province
Postal / Zip Code
What policy changes do you need to make?
Mark ALL that apply. Multiple items can be selected.
Mark all the changes needed:
*
Mortgagee Update
House Coverage Update
Barn, Shop, or Building Update
Equipment Update - Farm&Ranch
Animal / Livestock Update - Farm&Ranch
Something else
Mortgagee Update
Update Mortgagee or Loss Payee
Effective Date for this change
*
-
Month
-
Day
Year
Date
Add or Remove a Mortgagee / Lien holder?
*
Add Mortgagee or Lien holder
Remove Mortgagee or Lien holder
Replace/Update - Mortgagee or Lien holder
Does this Mortgagee / Lien holder apply Policy Wide or to Equipment?
*
Mortgagee - Policy Wide (most common)
Lien holder - applies to individual equipment or structure
I'm not sure
What Equipment or Structure does the Lien holder apply to?
*
Example: 2020 JD Tractor, 40x50 Pole Barn
Replace/Update a Mortgagee / Lien holder
Did you receive a notice from the Mortgagee or Lien holder?
*
Yes, I can upload it now (recommended)
No, I'll manually enter the Name, Address, & Loan info
Removing a Mortgagee / Lien holder
Did you receive a notice from the Mortgagee or Lien holder?
*
Yes, I can upload it now (recommended)
No, I'll manually enter the Name, Address, & Loan info
Upload Notice:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Remove Mortgagee / Lien holder
*
Name of Mortgagee to be removed
Remove Loan Number
*
Loan number of mortgagee being removed
Update the Policy Billing?
*
Yes, remove Escrowed/Mortgagee Billed. Policy will be Client Direct Billed
No, the policy billing is already Client Direct Billed. No update needed.
I'm not sure
Adding a Mortgagee / Lien holder
Did you receive a notice from the Mortgagee or Lien holder?
*
Yes, I can upload it now (recommended)
No, I'll manually enter the Name, Address, & Loan info
Upload notice:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Add Mortgagee / Lienholder
*
Include full Mortgagee clause if applicable. Example: ISAOA ATIMA
Loan Number (if Mortgagee required)
*
Address
*
Address
Address Line 2
City
State / Province
Postal / Zip Code
What position should this Mortgagee hold?
*
1st position
2nd position
3rd position
Other
I'm not sure
Update the policy to Mortgagee Billed?
*
Yes, the policy is Escrowed/Mortgagee Billed
No, the policy will be Client Direct Billed
I'm not sure
House Coverage Update
Updating House Coverage
Effective date for this change
*
-
Month
-
Day
Year
Date
Reason for coverage update? (Mark all that apply)
*
Increase House Coverage amount (Cov-A)
Add or Remove Equipment or Item (lawn mower, jewelry, etc)
Policy Review with Agent - New Addition/Remodel
Policy Review with Agent - Coverage/Discount Check
Other
Brief description or notes for your agent:
Structures Update
Updating Barns, Shops, or Buildings
What changes are needed? (Mark all that apply)
Add a Structure
Remove a Structure
Change a Structure
Adding Structures
Structure Name
*
Coverage Amount
No Required. Agent can recommend
Year Built
*
Size
*
Is there an attached Lean-to?
*
Yes
No
Lean-to Size
*
Construction Type:
*
Metal on Frame (most common)
Metal on Steel
Concrete Block
Other
Building Style:
*
Closed (all four sides can be closed by doors/windows)
Open (Any side is open. Example: Lean-to)
Building Upgrades (mark all that apply)
Plumbing / Bathroom
Electrical (Lighting & receptacles)
Insulation
Kitchenette / Bunkhouse / Apartment
Other
Are photos of the structure available to upload?
*
Yes, I can upload photos now
No, we will obtain photos later
File Upload
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Add another Structure?
*
No
Yes
Structure Name
*
Coverage Amount
No Required. Agent can recommend
Year Built
*
Size
*
Is there an attached Lean-to?
*
Yes
No
Lean-to Size
*
Construction Type:
*
Metal on Frame (most common)
Metal on Steel
Concrete Block
Other
Building Style:
*
Closed (all four sides can be closed by doors/windows)
Open (Any side is open. Example: Lean-to)
Building Upgrades (mark all that apply)
Plumbing / Bathroom
Electrical (Lighting & receptacles)
Insulation
Kitchenette / Bunkhouse / Apartment
Other
Are photos of the structure available to upload?
*
Yes, I can upload photos now
No, we will obtain photos later
File Upload
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Add another Structure?
*
No
Yes
Structure Name
*
Coverage Amount
No Required. Agent can recommend
Year Built
*
Size
*
Is there an attached Lean-to?
*
Yes
No
Lean-to Size
*
Construction Type:
*
Metal on Frame (most common)
Metal on Steel
Concrete Block
Other
Building Style:
*
Closed (all four sides can be closed by doors/windows)
Open (Any side is open. Example: Lean-to)
Building Upgrades (mark all that apply)
Plumbing / Bathroom
Electrical (Lighting & receptacles)
Insulation
Kitchenette / Bunkhouse / Apartment
Other
Are photos of the structure available to upload?
*
Yes, I can upload photos now
No, we will obtain photos later
File Upload
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Removing a Structure
Description of Structure
*
Year Built
*
Building Size
*
Current Coverage Amount
*
Reason coverage is being removed?
*
Building damaged or destroyed
No longer own / sold land
No longer want coverage / save premium
Other
Remove another structure?
*
No
Yes
Description of Structure
*
Year Built
*
Building Size
*
Current Coverage Amount
*
Reason coverage is being removed?
*
Building damaged or destroyed
No longer own / sold land
No longer want coverage / save premium
Other
Remove another structure?
*
No
Yes
Description of Structure
*
Year Built
*
Building Size
*
Current Coverage Amount
*
Reason coverage is being removed?
*
Building damaged or destroyed
No longer own / sold land
No longer want coverage / save premium
Other
Changing a Structure
Description of Structure
*
Year Built
*
Current Building Size
*
Current Coverage Amount
*
Reason for coverage change? (Mark all that apply)
*
Remodeled or Add-on
New Roof
Increase Coverage Amount
Other
Brief description or notes for the agent:
*
Are photos of the structure available to upload?
*
Yes, I can upload photos now
No, we will obtain photos later
Upload photos:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Make another structure change?
*
No
Yes
Description of Structure
*
Year Built
*
Current Building Size
*
Current Coverage Amount
*
Reason for coverage change? (Mark all that apply)
*
Remodeled or Add-on
New Roof
Increase Coverage Amount
Other
Brief description or notes for the agent:
*
Are photos of the structure available to upload?
*
Yes, I can upload photos now
No, we will obtain photos later
Upload photos:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Equipment Update - Farm & Ranch
Updating Farm Equipment
What changes are needed? (Mark all that apply)
Add Equipment
Remove Equipment
Change Equipment Coverage
Adding Farm Equipment
Equipment type:
*
Tractor
Hay Baler
Hay Rake
Hay Mower
Brush hog
UTV / Side by Side
Other
Year
*
Make, Model, Description
*
Serial Number
*
Coverage Amount
*
Add a lien holder for this item?
*
Yes
No
Yes, but I don't have that info right now
Lien holder
*
Lien holder address
*
Address
Address Line 2
City
State / Province
Postal / Zip Code
Are any photos available for this item?
*
Yes, I can upload photos now
No
Upload Photos:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Add another Equipment unit?
*
Yes
No
Equipment type:
*
Tractor
Hay Baler
Hay Rake
Hay Mower
Brush hog
UTV / Side by Side
Other
Year
*
Make, Model, Description
*
Serial Number
*
Coverage Amount
*
Add a lien holder for this item?
*
Yes
No
Yes, but I don't have that info right now
Lien holder
*
Lien holder address
*
Address
Address Line 2
City
State / Province
Postal / Zip Code
Are any photos available for this item?
*
Yes, I can upload photos now
No
Upload Photos:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Add another Equipment unit?
*
Yes
No
Equipment type:
*
Tractor
Hay Baler
Hay Rake
Hay Mower
Brush hog
UTV / Side by Side
Other
Year
*
Make, Model, Description
*
Serial Number
*
Coverage Amount
*
Add a lien holder for this item?
*
Yes
No
Yes, but I don't have that info right now
Lien holder
*
Lien holder address
*
Address
Address Line 2
City
State / Province
Postal / Zip Code
Are any photos available for this item?
*
Yes, I can upload photos now
No
Upload Photos:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Removing Equipment
Year
*
Make, Model, Description
*
Serial Number
*
Current Coverage Amount
*
Reason equipment is being removed?
*
Sold / Traded
Broken-down / Non-Operable
No longer want coverage / Save premium
Other
Remove another equipment unit?
*
Yes
No
Year
*
Make, Model, Description
*
Serial Number
*
Current Coverage Amount
*
Reason equipment is being removed?
*
Sold / Traded
Broken-down / Non-Operable
No longer want coverage / Save premium
Other
Remove another equipment unit?
*
Yes
No
Year
*
Make, Model, Description
*
Serial Number
*
Current Coverage Amount
*
Reason equipment is being removed?
*
Sold / Traded
Broken-down / Non-Operable
No longer want coverage / Save premium
Other
Changing Equipment Coverage
Open Carrier Website and locate Policy Details or Dec Page
Year
*
Make, Model, Description
*
Serial Number
*
Current Coverage Amount
*
What change is needed?
*
Increase/Decrease Coverage Amount
Change Lienholder
Remove/Add FO-61 (Special Coverage)
Other
Brief description or notes for agent:
*
Change coverage for another equipment unit?
*
Yes
No
Year
*
Make, Model, Description
*
Serial Number
*
Current Coverage Amount
*
What change is needed?
*
Increase/Decrease Coverage Amount
Change Lienholder
Remove/Add FO-61 (Special Coverage)
Other
Brief description or notes for agent:
*
Change coverage for another equipment unit?
*
Yes
No
Year
*
Make, Model, Description
*
Serial Number
*
Current Coverage Amount
*
What change is needed?
*
Increase/Decrease Coverage Amount
Change Lienholder
Remove/Add FO-61 (Special Coverage)
Other
Brief description or notes for agent:
*
Animals - Farm & Ranch
Updating Animal or Livestock Coverage
Add or Remove Animal coverage?
*
Add 4H / FFA Animal coverage
Remove 4H / FFA Animal coverage
Add Livestock coverage
Remove Livestock coverage
Other
Description of the change:
*
Other Changes
Other Policy Changes:
How can we help?
Submit Request
Please indicate if any lienholder information related to the home, vehicles, or equipment could not be provided at this time.
*
Yes, one or more lienholder could not be provided
No, all lienholder information was provided
Not Applicable, this question does not apply to my situation
Billing Review
Are you interested in Autopay, Paperless, &/or Text reminders? Selecting monthly-autopay can save $10 each month!
I'm interest. Please contact me with details.
*
Yes
No
Submit
Should be Empty: