219 Greenwood Ave.
Bethel, CT 06801
Phone: (203) 748-4233
Fax: (203) 794-9638
Info@Mccollamagency.com

Request to Delete a Driver from My Auto Policy (NY)

Binding Agreement

(Required) I understand that any policy changes and quote requests are effective only when I have received a written confirmation.*

I agree

Requestor Information

First Name:*

Last Name:*

Email Address:*

Phone Number:*

We will confirm the policy change by email. If you prefer a FAX, please provide a FAX number.

Policy Holder Information (if different than requestor)

Policy Number (required if you have more than 1 auto policy)

First Name:

Last Name:

Driver to be Deleted from Policy

First Name:*

Last Name:*

Date of Birth:

Reason:*

Date to Remove Driver:*

Please explain why you are requesting removal of this driver from your policy (e.g., moved, has own insurance, etc. Note: many of our insurance companies will require documentation such as a copy of a utility bill; rent receipt; legal notice for suspended licenses; copy of policy for replacing insurance, etc.)

Questions or Comments

*Required fields:

This submission is a request. Insurance coverage changes and new coverages are not effective until we confirm that for you.

We will do our best to complete this request based on the information you provide. The more complete your information, the more accurate your quote will be.

Security:
The security of your personal information is important to McCollam Insurance Agency. Our site uses SSL encryption to ensure your personal information is sent securly to us.

McCollam Insurance Agency
Insurance Marketing