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Home
Current Clients
Need Insurance?
Why Hershfield?
News & Resources
Contact Us
Need A Quote?

Buy a new car? New address?

We've made it easy & convenient to

UPDATE YOUR INSURANCE POLICY!

Which Policy Do You Need To Service?*
- Home Policy
- Auto Policy
- Other

Your Name*
First Last
Callback Number*
Email*
Type of Policy*
Change Needed*
Consent*
By submitting this form I understand that my changes are not immediately put into place and that I will be contacted by someone at HIA to confirm.*

Please Select The Home Changes You Need To Make*
- Change Mortgage Company
- Add More Personal Property Coveage
- Change Your Mailing Address
- Other

New Mortgage Company*
Mortage Company Name and Street Address Loan Number City State ZIP Code

Who should receiving the bills for your insurance premium?*
- Bill to this Mortgage Lender
- Send Bill Directly to Me

Please Specify The Items Needing Coverage And Their Individual Values

New Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please Specify Your "Other" Changes. Be As Specific As Possible*

Please Select The Changes You Need To Make*
- Add Or Replace A Car
- Remove A Car
- Add A Driver
- Remove A Driver
- Add A Lienholder
- Change Your Mailing Address
- Change Deductible
- Other

Your Name*
First Last

Which Car Are You Removing? (Yr, Make, Model)*

Reason For Removal?*
- Sold
- Non Operational (this option will require proof of filing Non-Op with the DMV)

When Did You Get Rid Of The Car? (Specific Date)*

How long has this driver been licensed?*

New Driver Full Name*

New Driver Date Of Birth*

New Driver DL#*

New Driver Relation To You*

New Driver's Employer or School*

Current High School Student With A 3.0 or Better GPA?*
- Yes
- No
If the new driver is a student with a 3.0 or better GPA and is full-time or carrying a minimum of 12 units, they may qualify for a good student discount. You will need to submit proof (last report card) to [email protected].

Name Of Driver You Are Removing?*

Is This Person Still A Household Resident?*
- Yes
- No

Bank Name*

Which Vehicle Is This For?*

New Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please Specify Your "Other" Changes. Be As Specific As Possible*

Is This New Car Replacing Another Car?*
- Yes (Replace A Current Car With A Different Car)
- No (This Is A New Car To Me)

Have you already purchased the car?*
- Yes, it’s been purchased. NOTE: Hershfield will be updating your existing auto policy which may result in a change in your premium
- No, I am planning to purchase this car.

Please visit our quote page for a quote.

Which Of Your Vehicles Are You Replacing With The New Car? (Year/Make/Model)?*

What is the year/make/model of your NEW CAR?*

How Will The New Car Be Used?*
- Pleasure
- Work/School Commute
- Business/Commercial (Select this option if you occasionally drive clients in your car. Example: Realtor)

How Many Miles Will This Car Be Driven Annually?*

The CA DMV says the average commuter will drive approximately 13,000 miles a year.

What Is The 17 Character VIN# Of Your New Car?*

Please double check your entry to make sure it's correct.

What Is The Odometer Of Your New Car?*

What Was The Purchase Date?*

Check the coverage options you would like:*
- Comprehensive
- Comprehensive & Collision (Necessary if your car is financed or leased)
- Liability only

What Comprehensive Deductible Would You Like?*
- Match my current deductible
- $250
- $500
- $1000
Comprehensive covers everything other than an at fault accident. Ex. Theft, vandalism, a rock cracking your windshield on the freeway, etc.

What Collision Deductible Would You Like?*
- $100
- $250
- $500
- $1000
NOTE: The lower the deductible, the higher the premium.

Is your car:*
- Leased
- Owned – No payments
- Owned – Financed and making car payments

What vehicle does this deductible change pertain to? (Make & Model)*

Is There A Lien Holder? If So, Who?*

If none, enter "none"

Lien Holder Address*
Street Address Address Line 2 City State ZIP Code

Lien Holder Name
First Last

Lien Holder Address*
Street Address Address Line 2 City State ZIP Code

Who Is The Primary Driver?*

If none, enter "none"

Mobile Number*

Email*

Did you know we have an app?

Check your policy, print documentation, & more right from your phone!

Click the button below and you’ll receive a text to download the app!

Text me a link for the app

*Message charges may apply based on your carrier and plan.

Hershfield Insurance Agency | 4909 LakewooD Bl Suite 501, lakewood CA 90712 US

+1.866.996.9760 phone | +1.866.996.9761 fax | [email protected]