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Give us your Delete vehicle information We will then verify the change with you directly. No change will be made until we verify with you.**
	Send us DMV's receipt after turning in the license plates to make the change.

Current Auto Policy Number:
Name on Policy:
Insurance Company
Full Name:
Email Address:
Daytime Telephone Number:
DELETE VEHICLE INFORMATION
Effective Date of FS6 (DMV Receipt) (mm/dd/year)
Vehicle Identification #
Year of Vehicle:
Make of Vehicle:
Model of Vehicle:

**By completing this form, you are acknowledging your understanding of and agreement with these terms
Bianchi Agency - 2301 Milton Ave - Solvay, NY 13209 - CNYINS@gmail.com Home Page