Add Vehicle to Policy Personal InformationName* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Primary Phone*Please enter number we can call should we have any questions about your request.Email* Policy InformationInformation to help us serve you better and faster.Policy Number*Current Insurance ProviderOptionalAdd Vehicle InformationThe same coverages & deductibles will be applied to this vehicle at the highest limits currently on the policyAre you replacing an existing vehicle with this one?*YesNoDate Add to Policy will take Effect:* Date Format: MM slash DD slash YYYY Year*Make*Examples: Ford, Chrysler, Dodge, ToyotaModel*Examples: Mustang, IS250, EdgeOwnership*OwnedFinancedLeasedLender NameIf known, please share. If not known, we will be in touch.Lender AddressIf known, please share. If not known, we will be in touch. Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Lease CompanyIf known, please share. If not known, we will be in touch.Lease Company AddressIf known, please share. If not known, we will be in touch. Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Vehicle Identification Number (VIN)If known, please enter. If not known, we will be in touch.ID Cards and/or Binders - How would you like them delivered?*EmailFaxPick-up at our OfficeMail to Policy Mailing AddressContact Name*Contact Email* Fax Number*Keating Agency Insurance West Hartford Center 10 Arapahoe Road West Hartford, CT 06017Remove Vehicle InformationIs the Remove Vehicle Date different from the Add Vehicle Date?*YesNoDate Remove will take Effect:* Date Format: MM slash DD slash YYYY Year*Make*Examples: Ford, Chrysler, Dodge, ToyotaModel*Examples: Mustang, IS250, EdgeDispose Reason*SoldTradedWreckedGiftedOtherSection BreakSecurity