Add or Delete Drivers and Equipment Vehicle Change Request Form If you need to add/delete/change more than one vehicle/driver, please complete the attached form. Once completed, please fax or email the form to: (714)546-4457, or via email to: PolicyChange@rsi-ins.com Step 1 of 2 50% Insured* Email* Name First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Client Code* PhoneFax Requested By* Effective* Action Add Delete Change Vehicle InformationYear and Make of Vehicle* Vehicle Type* Vehicle Serial #* Vehicle Value* Additional Insured Info*(Please include name and address below)Loss Payee Info*(Please include name and address below)If available, do you want any additional premium added to a current finance agreement?* Instructions/Information/Comments Δ
