Remove Vehicle Auto Policy in West Hartford, CT

Auto Remove Vehicle Request

Client Service – Remove Vehicle from Existing Auto 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
Remove Vehicle Information
Are you Adding a Vehicle to Replace this one?*
- Yes
- No
Date Remove from Policy will take Effect:*
MM slash DD slash YYYY
Year*
Make*
Examples: Ford, Chrysler, Dodge, Toyota
Model*
Examples: Mustang, IS250, Edge
Dispose Reason*
Add Vehicle Information
The same coverages & deductibles will be applied to this vehicle at the highest limits currently on the policy
Is the Add Vehicle Date different from the Remove Vehicle Date?*
- Yes
- No
Date Add to Policy will take Effect:*
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
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Remove Vehicle Auto Policy

Auto Remove Vehicle Request

Personal Information

Policy Information

Remove Vehicle Information

Add Vehicle Information

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