CLIENT SERVICES

Policy change - Follow the easy step-by-step instructions in order to make a change to your policy. All policy change request must be returned by fax or by mail with a signature of the policy holder or named insured.

The policy changes will not take effect until receipt and final approval by the insuring company.

Step 1 - Select the policy change you wish to make and complete the form in it's entirety. Then print the completed form for the policy holder/named insured signature.

Step 2 - Policy holder/named insured must sign where indicated.

Step 3 - Print and Fax the completed form to 909-949-1072 or mail the completed form to:

Sumner Insurance Services
280 N. Benson Ave. #1
Upland, CA 91786
Attn: Policy change

• ADD - A copy o f the driver's license must be returned with this form when adding a driver
• REMOVE - An additional Driver Exclusion form the carrier will be sent for you to sign and return.

Policy holder / named insured must sign and date below:

By signing below for you policy change, the policy holder / named insured agrees and understands that the insurance company coverage has the final approval and authority as the effective date of the change request. Additionally, it is under stood that the above form must be completed in its entirety. Incomplete change request will result in a delay of the effective date requested change. Any changes to your policy may require payment for an additional deposit and or additional premium to make such changes. Sign below and return with required items as needed.