indicate if new vehicle is:
an additional vehicle
hired auto (Representative will contact you)
Effective date of
No. (VIN) of new vehicle:
New vehicle State
If replacement, Vehicle
I.D. Number (VIN) or year, make, model of deleted vehicle:
If replacement, are
plates being transferred to replacement vehicle?
If no, the following
documentation* is required to remove a vehicle:
Proof of license
Copy of receipt from DMV
Bill of sale
Proof of Lease turn in
Lease termination paperwork OR
Odometer statement at end of lease
Proof of other insurance
for that vehicle
of the above items must be received by our office prior to the removal
of a vehicle from your policy. The vehicle will be removed effective
the day after the plates were surrendered, the lease was terminated or the
vehicle was otherwise insured.
Documentation may be forwarded via:
U.S. MAIL: LimoDirect, 370 West Park Avenue, Long
Beach, NY 11561
FAX: (516) 889-9130
E-MAIL attachment: email@example.com
Name of Loan/Lease
, (state & zip):
Requested Coverages (Liability
coverages must be same as existing policy)
Actual Cash Value:
transactions may require additional information and/or documentation. Please provide your e-mail address or a daytime telephone number.
confirming paperwork is not received within 5 business days, please
telephone our office at 800-782-8902 x3042.
(Time to Call)
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