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Add Vehicle to Policy

Personal Information
Name*
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 Information
Information to help us serve you better and faster.
Policy Number*
Current Insurance Provider
Optional
Add Vehicle Information
The same coverages & deductibles will be applied to this vehicle at the highest limits currently on the policy
Are you replacing an existing vehicle with this one?*
- Yes
- No
Date Add to Policy will take Effect:*
Date Format: MM slash DD slash YYYY
Year*
Make*
Examples: Ford, Chrysler, Dodge, Toyota
Model*
Examples: Mustang, IS250, Edge
Ownership*
Lender Name
If known, please share. If not known, we will be in touch.
Lender Address
If known, please share. If not known, we will be in touch.

Street Address Address Line 2 City State ZIP Code
Lease Company
If known, please share. If not known, we will be in touch.
Lease Company Address
If known, please share. If not known, we will be in touch.

Street Address Address Line 2 City 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?*
- Email
- Fax
- Pick-up at our Office
- Mail to Policy Mailing Address
Contact Name*
Contact Email*
Fax Number*
Keating Agency Insurance
West Hartford Center
10 Arapahoe Road
West Hartford, CT 06017
Remove Vehicle Information
Is the Remove Vehicle Date different from the Add Vehicle Date?*
- Yes
- No
Date Remove will take Effect:*
Date Format: MM slash DD slash YYYY
Year*
Make*
Examples: Ford, Chrysler, Dodge, Toyota
Model*
Examples: Mustang, IS250, Edge
Dispose Reason*
Section Break
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