The Frigault Agency, Inc. Protecting all the things you love. Auto, Home, Life, Business, Boat.
 (315) 797-8080
136 Clinton Road (Rt 12b), New Hartford, NY, 13413
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Automobile Policy Change Request

You may use the form below to submit an automobile policy change request directly to one of our agents. An agent from our office will contact you shortly after receiving the request.

Please Note:
No coverage can be changed, modified or altered as a result of this request until you hear from one of our agents from our office.

Policy Holder Information
Name of Insured:
Phone #:     E-Mail:
Desired Effective Date
of Change:


To ADD a driver:
Name:
Relationship:     DL#:
Date of Birth:     SS#:
Does He/She have a Defensive Driving Certificate? Yes     No
Does He/She have a Drivers Training Certificate? Yes     No


To DELETE a driver:
Name:
Reason:


To ADD a vehicle:
Year:     Make
Model:     Serial #:
Cost: $
Anti-Lock Brakes: 0     1     2
Air Bags: None   Driver     Driver/Passenger
Anti-Theft Device: Yes     No
How will car
be driven?
(Check One):
Farm     To/From Work     In Business
Car Pool Pleasure


To DELETE a vehicle:
Effective Date
of Change:
Year:     Make:
Model:     Serial #:


   

We help you find the right solution by understanding your needs. Give us a call(315) 797-8080
136 Clinton Road (Rt 12b), New Hartford, NY, 13413