ADDRESS CHANGE CHEAT SHEET

Toady’s date________________ Time taken_________________

Company____________________________ Policy #__________________________

Insured______________________________ Effective Date of Change____________

New Address_________________________ New Phone #_____________________

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Occupation___________________________ Employer _______________________

Miles to Work_________________________ Annual miles driven_______________

Did you move to a house or apartment?________Did you buy or are you renting?______

If bought – need to refer to a homeowner app and complete along with a photo and rc.

If renting –

Type of construction of apartment building?_____________________

Approximate year of construction of apartment building?___________

# of apartments in the building?_____________

# of rooms in the apartment?________________

# of feet from fire hydrant?__________________

# of miles from fire department?______________

Name of responding fire department?____________________

Remarks:________________________________________________________________

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