Tough 2 Beat Insurance

6223 Van Nuys Boulevard
 Van Nuys, CA 91401

 

Add New Vehicle  

 
Disclaimer:
I understand that this does not constitute an actual claim, but is rather a notification to my agent of an existing loss or claim, and may help expedite the claim process once I have filed.

I have read and agree with the above
(Box must be checked before request can be sent)
 

Policy Holder Information

Please be sure to supply your phone number and email address so that we may contact you after receiving this notification.

Name Insured:

Address:

City:

State:

Zip Code:

Home Phone:

Email:
Vehicle Information  

Vehicle Year*

Vehicle Make*

Vehicle Model*

Date of Purchase
(mm/dd/yyyy)*

Primary Driver's Name*

Mileage to work (one way)*

Annual Miles*

Garaging Street Address

Garaging City

Garaging State

Garaging Zip Code

Coverages
California Casualty will add the vehicle with the existing Bodily Injury, Property Damage, Medical Payments and Uninsured/Underinsured Motorists Coverages currently showing on your policy.

Depending on your state, selection of Towing and Rental Reimbursement/Transportation coverages may require that the coverages be applied to all eligible vehicles we insure in the household. If you have vehicles that we insure that do not currently have these coverages, and you select them here, we will add the coverages to the qualifying vehicles. If you currently have Towing and Rental Reimbursement/Transportation coverages on your policy and do not select them here, we will add them to this vehicle.

Comprehensive Coverage*

No ded.

$250 ded.

$50 ded.

$500 ded.

$100 ded.

$1000 ded.

No Coverage

Collision Coverage*

$50 ded.

$200 ded.

$100 ded.

$250 ded.

$150 ded.

$500 ded.

No Coverage

$1000 ded.

Is This Vehicle Leased?

Yes No

Replacing Vehicle?*

Yes No

Which Vehicle?

Effective Date*
(mm/dd/yyyy)

If this is fourth vehicle on your policy, it may take up to 21 days to receive written confirmation.
Please note, this transaction is not effective until you receive a confirming call, email or the Policy Declarations page showing the change.