Add / Remove a Driver Policy Holder InformationName* First Name Last Name Street* City* State* Zip / Postal Code* Primary Phone Number*Alternate Phone NumberE-Mail Address* Policy Number* Current Insurance Provider Add or Remove a Driver Information* Add a Driver - New Driver Information Remove a Driver - Driver Information Add a Driver - New Driver InformationName of Driver (First, Last)* Gender*MaleFemaleMarital Status*SingleMarriedSeparatedDivorcedWidowedWhen will this change take effect?* MM slash DD slash YYYY Relationship*SpouseChildRelativeParentNon-RelativeLicense State* License Number* Date of Birth* MM slash DD slash YYYY Does this driver have any major violations (5yrs), accidents or minor violations (3yrs), comprehensive or collision claims (3yrs)?Not SureYesNoDISCLAIMER: Any changes/requests/quotes expressed over the internet can only be honored after Slemp Brant Saunders Insurance Agency has acknowledged the receipt of the change and after underwriting approval. Changes expressed in emails or messages are not bound automatically. All new policies and changes are subject to verification and underwriting approval. Customer Service hours at Slemp Brant Saunders Insurance Agency are Monday-Friday 8:30 AM – 5:00 PM.Remove a Driver - Driver InformationName of Driver (First, Last) When will this change take effect? MM slash DD slash YYYY DISCLAIMER: Any changes/requests/quotes expressed over the internet can only be honored after Slemp Brant Saunders Insurance Agency has acknowledged the receipt of the change and after underwriting approval. Changes expressed in emails or messages are not bound automatically. All new policies and changes are subject to verification and underwriting approval. Customer Service hours at Slemp Brant Saunders Insurance Agency are Monday-Friday 8:30 AM – 5:00 PM. File A Claim / Make Payment Policy Change Request Form Certificate of Insurance Request Form Add/Remove a Driver Add/Remove Vehicle to Auto Policy Refer a Friend Auto I.D. Card Request Form FAQ’s
