Serving Clients in Chicago and Globally for over 50 years
Submitting a Claim

Client Automobile Change Request Form

The effect date and time of this change will be on the date it is received and reviewed by IIA personnel. Normally that will be by noon the next business day if received overnight or on the weekend. We review all change requests on the hour during normal business hours.

Your Name:
Company:
E-mail:
Day Telephone:
Fax:
 
Please Make the Following Change to Our Policy:
 
Delete the Following Vehicle:
Year/Make/Model:
Last 4 Digits of SS#:
 
Add the Following Vehicle:
Year/Make/Model:
Complete Serial #:
Cost New:
   Purchase
 Lease
Garaged Location:
Lienholder (Loss Payee) or Lessor: