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ON-LINE VEHICLE SCHEDULE CHANGES FORM
 Your Name:
Today's Date : 7/30/2010 6:24:39 PM
 Named Insured: Policy Number:
 Your Email: Phone Number:
  Broker
  Insured
(When submitted through www.BedfordInsurance.com, a copy of this request will be emailed to the email address provided above.)
PLEASE COMPLETE ALL FIELDS FOR EACH ADDED/DELETED VEHICLE
# Add Delete Year Make Model VIN
(Include full vehicle identification number for additions and last 6 numbers for deletions)
 Include Physical Damage* Delete Physical Damage* Effective Date of Change*
( MM/DD/YY )
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Comments:


*INCLUDE PHYSICAL DAMAGE – Physical damage will be included for newly added vehicles only when such coverage has been previously quoted and approved by Bedford Insurance Services, INC.
*EFFECTIVE DATE OF CHANGE – Please refer to the “Procedures for Adding and Deleting Vehicles” form.

NOTE: AN UPDATED VEHICLE SCHEDULE WILL BE MAILED FOR ALL ADDITIONS AND DELETIONS RECEIVED BY BEDFORD. IF YOU DO NOT RECEIVE AN UPDATED VEHICLE SCHEDULE WITHIN 2 WEEKS OF REQUESTING THE CHANGE, PLEASE CALL BEDFORD IMMEDIATELY AT (800) 669-9800.

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