Policy Change Request - Charles String Insurance

Business Name(Required)

Email(Required)

What kind of changes do you need to make?(Required)

Drivers

Vehicles

Trailers

Policy Coverages / Limits

Address - Business / Mailing / Garaging

Driver Changes

I need to:

Add a Driver

Remove a Driver

Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

Driver's License Number(Required)

Licensed State(Required)

Is this license a CDL?(Required)

Yes

What year was the CDL first Issued?(Required)

Do you have a copy of the MVR for this driver?

Yes

Upload MVR

Max. file size: 12 MB.

MVR must be dated within 30 days.

This driver is a(Required)

Company Driver (W-2 Employee)

Contract Driver (1099 Contractor)

Owner Operator (1099 Contractor + Truck)

This driver was a(Required)

Company Driver (W-2 Employee)

Contract Driver (1099 Contractor)

Owner Operator (1099 Contractor + Truck)

Do you have a signed Lease Termination Agreement?(Required)

Yes

Upload the Lease Termination here

Max. file size: 12 MB.

Vehicle Changes

Add / Remove Vehicle(Required)

Add a Vehicle

Remove a Vehicle

Type of vehicle?(Required)

Semi Truck

Box Truck

Hot Shot

Cargo Van

Dump Truck

Tow Truck

This is a __________ vehicle.(Required)

Company

Rental

Owner Operator's

Is the vehicle financed or leased?(Required)

Yes

Vehicle VIN(Required)

Last 4 of Vehicle VIN

Vehicle Year

Vehicle Make

Vehicle GVW

Would you like to add physical damage to this vehicle?(Required)

Yes

Current Market Value of this vehicle?(Required)

Lender / Leinholder Name

Lender / Leinholder Address

Street Address Address Line 2 City State ZIP Code

Lender / Leinholder's Email

Will the garaging address be the same as your current vehicle(s)?(Required)

Yes

Garaging Address for this vehicle?(Required)

Street Address Address Line 2 City State ZIP Code

Will the radius of operation be the same as your current vehicle(s)?(Required)

Yes

Did you sell the vehicle?(Required)

Yes

Upload bill of sale

Max. file size: 12 MB.

If you don't have the bill of sale yet, we will send you an email where you can attach it and reply.

Trailers

Add / Remove Trailer(Required)

Add a Trailer

Remove a Trailer

This is a __________ trailer.(Required)

Company

Rental

Owner Operator's

Is the trailer financed or leased?(Required)

Yes

Trailer VIN(Required)

Last 4 of Trailer VIN

Trailer Year

Trailer Make

Would you like to add physical damage to this trailer?(Required)

Yes

Current Market Value of this trailer?(Required)

Lender / Leinholder Name

Lender / Leinholder Address

Street Address Address Line 2 City State ZIP Code

Lender / Leinholder's Email

Coverage / Limit Change

Change type(Required)

Add line of coverage

Remove line of coverage

Increase coverage limit

Decrease coverage limit

Adding(Required)

General Liability

Cargo

Physical Damage

Worker's Comp

Umbrella

Cargo Limit(Required)

100,000

150,000

200,000

250,000

500,000

Last 4 of VIN to add Physical Damage(Required)

What is the current market value?(Required)

Removing(Required)

General Liability

Cargo

Physical Damage

Worker's Comp

Umbrella

Last 4 of VIN to remove Physical Damage(Required)

Increasing(Required)

Auto Liability

Cargo

Physical Damage

Decreasing(Required)

Auto Liability

Cargo

Physical Damage

Requested Auto Liability limit(Required)

$300,000

$750,000

$1,000,000

$1,500,000

$2,000,000

Requested Cargo limit(Required)

$100,000

$150,000

$200,000

$250,000

$500,000

Last 4 of VIN to increase Physical Damage limit(Required)

Requested Physical Damage limit(Required)

Check which addresses you need to update.(Required)

Business

Mailing

Garaging

Have you requested this update with the FMCSA already?(Required)

Yes

Not Applicable

Business Address(Required)

Street Address Address Line 2 City State ZIP Code

Mailing Address(Required)

Same as previous

Street Address Address Line 2 City State ZIP Code

Will you have the same garaging address for all vehicles?(Required)

Yes

Garaging Address(Required)

Same as previous

Street Address Address Line 2 City State ZIP Code

Comments

Is there anything else we should know about your request?

***If your request will impact the cost of your policy, we will quote the change first and confirm with you via email before making the request effective.

Driver Changes

Vehicle Changes

Trailers

Coverage / Limit Change

***If your request will impact the cost of your policy, we will quote the change first and confirm with you via email before making the request effective.

Contact Us

Follow Us

Get A Quote

Resources

Our Agency

For Clients