Changes to Floater

Requested changes are not effective until accepted by us and verified in writing. We will make every effort to contact you on the next business day. If we fail to do so please call our office immediately.

IDENTIFY YOUR POLICY

Policy Number
Effective Date of Change

IDENTIFY THE NAMED INSURED

First name *
Last name *
Daytime telephone number
Alternate telephone number
Email address *

ADD WHICH ITEMS TO YOUR POLICY

Describe the items as completely as possible. The description and value are located on the purchase agreement or appraisal. Be prepared to prove the value of each item if requested to do so.

Item #1		$
Item #2		$
Item #3		$
Item #4		$
Item #5		$
Item #6		$
Item #7		$
Item #8		$

DELETE WHICH ITEMS TO YOUR POLICY

Describe the items to be deleted

Item #1		$
Item #2		$
Item #3		$
Item #4		$
Item #5		$
Item #6		$
Item #7		$
Item #8		$

Clarification or Comments

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