Please enable JavaScript in your browser to complete this form.1About You2About Your New Vehicle3About Any LienholderName *FirstLastBusiness/dbaPhoneFaxEmail Address *Your Policy NumberPlease Note: Your submitted changes do not take effect immediately. An Aloha Customer Service Representative will review and implement policy changes, and will contact you for additional information if necessary.NextExisting VehicleThis is an existing vehicleIf you wish to add a Lienholder to a vehicle already listed on your policy, fill in this section with the information about your existing vehicle and check this box.YearMakeModelVIN NumberMileageAdd Comp & Collision Coverage with a deductible ofDon't Add1002505001,0001,5002,0002,500Comprehensive coverage (“Comp”) covers your vehicle, and sometimes other vehicles you may be driving, for losses resulting from incidents other than collision. For example, comprehensive insurance covers damage to your car if it is stolen, or damaged by flood, fire or animals. It pays to fix your vehicle, less the deductible you choose. To keep your premiums low, select as high a deductible as you feel comfortable paying out of pocket. Coverage is limited to the terms and conditions contained in the policy. This is not required by the state, but if you have a loan or a lease then the lienholder will require it. Collision coverage (“Collision”) covers damage to your car when your car hits, or is hit by, another vehicle or other object. It pays to fix your vehicle, less the deductible you choose. To keep your premiums low, select as large a deductible as you feel comfortable paying out of pocket. For older cars, consider dropping this coverage, since coverage is normally limited to the cash value of your car. Coverage is limited to the terms and conditions contained in the policy. This is not required by the state, but if you have a loan or a lease then the lienholder will require it.Date you would like this vehicle added to your policyHow will this vehicle be primarily used?Who will be primarily using this vehicle?Please Note: Your submitted changes do not take effect immediately. An Aloha Customer Service Representative will review and implement policy changes, and will contact you for additional information if necessary.PreviousNextIs there a lienholder on this vehicle?NoYesLienholder Name/dbaAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneFaxEmail AddressLien NumberDoes this Lienholder require a certificate of insurance?YesPlease Note: Your submitted changes do not take effect immediately. An Aloha Customer Service Representative will review and implement policy changes, and will contact you for additional information if necessary.PreviousSubmit
