Fodor Companies
 
3308 Lorain Avenue
Cleveland, Ohio 44113
 
216.631.0116
REQUEST POLICY CHANGE - AUTO
INSURED INFORMATION...
(* denotes required field)
Policy Holder's Name:
  *
Your Name:
  *
Phone:
 *
Street Address:
    
Fax:
   
P.O. Box/Suite:
    
E-Mail:
   
City:
          
State:
          
Zip Code:
          
ADD, REMOVE, OR CHANGE AN AUTOMOBILE...
 
ADD A VEHICLE
 
Effective Date:
Purchased:
Leased:
Vehicle Year:
Manufacturer:
Model:
VIN (17 digits):
Name of Principal Operator:
Garaging Zip Code:
Cost New $:
 
FINANCED BY
(Loss Payee)
ADDITIONAL INSURED
(if different than Financing Company)
Name:
Attention:
Street Address:
P.O. Box/Suite:
City:
State:
Zip:
Additional Insured's Name:
Attention:
Street Address:
P.O. Box/Suite:
City:
State:
Zip:
 
REMOVE A VEHICLE
 
Effective Date:
Vehicle Year:
Manufacturer:
Model:
VIN (17 digits):
 
OTHER VEHICLE REQUESTS (including Coverage Changes)
 
 
 
 
 

ADD OR REMOVE A DRIVER...
 
ADD A NEW DRIVER...
New Driver Name:
Date of Birth:
Social Security No.
    
Driver's License No.
State Issuing License:
 
REMOVE A DRIVER...
 
Driver Name:
Date of Birth:
 

 
 
Notifications or changes are not effective until confirmed.
If you do not receive confirmation, please contact Fodor Companies at 216.631.0116.
 
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