Vehicle Change Request J. Chapman, Inc.1100 Long Pond Road, Suite 119Rochester, NY 14626(585) 227-1181joshuachapman@allstate.com Policy Holder * Please make sure this is the name of the primary insured. First Name Last Name Policy Holder Phone # * (###) ### #### Policy Number Typically these will begin with 978, 933, 013, 078 Effective Date Of Vehicle Change * IE: When are you going to the DMV? Or when are you picking up the vehicle from the dealership? MM DD YYYY Are You Transferring Plates? * Yes No Vehicle You Are Transferring From? You only need to fill out this box if you are transferring plates! New Vehicle * VIN For Your New Vehicle * This should be 17 digits How Will This Vehicle Be Financed? * Lease Loan Cash Finance Company Name You only need to fill this out if you are financing the vehicle. Dealership and Salesperson Please fill this out if you are working with a car dealership. Salesperson's Email Salesperson's Phone # (###) ### #### Thank you! We will be in touch with you within 24 hours!
