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Replace a Vehicle to Existing Auto Policy
Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.
Personal Information
Policy#
Optional
Submitter Name
Required
Submitter Name is required.
E-Mail Address
Required
You must provide an e-mail address.
A valid e-mail address is required.
Submitter Fax #
Optional
Vehicle Information
Effective Date
Required
Effective Date is required.
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Replace Vehicle
Required
Replace Vehicle is required.
select
Yes
No
Vehicle To Replace
Required
Vehicle To Replace is required.
New Vehicle Year
Required
New Vehicle Year is required.
Make
Required
Make is required.
Model
Required
Model is required.
Vin #
Required
Vin # is required.
Date of Purchase
Required
Date of Purchase is required.
Open the calendar popup.
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Coverage Information
Comprehensive Deductible
Required
Comprehensive Deductible is required.
select
No Coverage
$250
$500
$1000
Collision Deductible
Required
Collision Deductible is required.
select
No Coverage
$250
$500
$1000
Towing And Labor
Required
Towing And Labor is required.
select
No Coverage
$25
$50
$75
$100
Rental Reimbursement
Required
Rental Reimbursement is required.
select
No Coverage
$25 / $750
$30 / $900
$40 / $1200
$50 / $1500
Vehicle Usage
Required
Vehicle Usage is required.
select
Work
School
Business
Pleasure
Days Driven To Work / School Per Week
Required
Days Driven To Work / School Per Week is required.
select
0
1
2
3
4
5
6
7
Miles To Work / School (1 Way)
Required
Miles To Work / School (1 Way) is required.
select
5
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Annual Miles
Required
Annual Miles is required.
Vehicle Operator
Required
Vehicle Operator is required.
Insure's Information
First Name
Required
Input Required
Last Name
Required
Input Required
Property Street Address
Required
Property Street Address is required.
City
Required
Input Required
State
Required
Input Required
select
TX
ZIP / Postal Code
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Input Required
Please enter a valid Postal code.
Primary Phone Number
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Input Required
Please enter a valid phone number
If there is any additional information that can help us process your request please enter it here.
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to
contact us
.
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Our Contact Info
Henrich Insurance Group
13920 Osprey Ct, Suite B
Webster, TX 77598
Local: 713-349-0400
Toll Free: 877-349-0200
Fax: 713-349-8485
www.HIGTexas.com
Also Serving: Houston, Webster, Clear Lake, Galveston, Seabrook, League City, Kemah, Texas
Henrich Insurance Group © 2011