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Call Us (804) 675-4300

Client Service Center
- Contact Us
- About Us
Business Insurance
Personal Insurance
Life Insurance

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Change My Policy

Personal Policies
Business Policies

Insured's Information
Name*
First Last
Email*
Contact Phone Number*
Policy #
Effective Date of Change*
MM slash DD slash YYYY
Type/s of Policy Changes
- Auto Changes: Add/Remove Vehicle
- Auto Changes: Add/Remove Driver
- Other Auto Changes
- Homeowner Changes
- Lienholder/Mortgagee Information Changes
- Other/ Miscellaneous Changes
Check all that apply
Auto Policy Changes: Add/Remove Vehicle
Important: When adding a vehicle, all fields marked with * are required for your request to be processed.

Please note: To remove any vehicle, remember it is your responsibility to notify DMV and turn in plates as instructed.
Vehicle 1*
- Add
- Remove
- Add same coverages as deleted vehicle
Vehicle 1 Year*
Vehicle 1 Make & Model*
Vehicle 1 VIN*
Primary Driver
First Last
Garaging Zip Code
Vehicle 1 Options
- Liability Only
- Add Physical Damge
- Remove Physical Damge
Vehicle 1 Use*
Comp. Ded.
Coll. Ded.
Do you have a second Vehicle to Add/ Remove?*
- Yes
- No
Vehicle 2*
- Add
- Remove
- Add same coverages as deleted vehicle
Vehicle 2 Year*
Vehicle 2 Make & Model*
Vehicle 2 VIN*
Primary Driver
First Last
Garaging Zip Code
Vehicle 2 Options
- Liability Only
- Add Physical Damge
- Remove Physical Damge
Vehicle 2 Use*
Comp. Ded.
Coll. Ded.
Auto Policy Changes: Add/Remove Driver
Important: When adding a vehicle, all fields marked with * are required for your request to be processed.

Please note: To remove any vehicle, remember it is your responsibility to notify DMV and turn in plates as instructed.
Driver 1*
- Add
- Remove
Driver 1 Name*
First Last
Driver 1 SSN*
Driver 1 DL#*
Driver 1 DOB*
MM slash DD slash YYYY
Do you have a second Driver to Add/Remove?
- Yes
- No
Driver 2*
- Add
- Remove
Driver 2 Name*
First Last
Driver 2 SSN*
Driver 2 DL#*
Driver 2 DOB*
MM slash DD slash YYYY
Other Auto Changes
Other Auto Changes*
Homeowner Changes
When making changes to a Homeowner Policy, all fields marked with * are required for your request to be processed.

When adding scheduled items to policy, your Agent will require an appraisal detailing the items to be added.
Change Liability Limits $*
Increase Building Value $*
Add Scheduled Item*

Describe item + value
Change Deductible $*
Other Changes*
Lienholder/Mortgagee Information
1st Lienholder/Mortgagee Information*
- Change
- Add
- Remove
1st Lienholder/Mortgagee Information to:*
2st Lienholder/Mortgagee Information
- Change
- Add
- Remove
1st Lienholder/Mortgagee Information to:*
Miscellaneous Changes
Describe Changes*
Authorization
Last Four Digits of SSN*
By typing your full name in the box below, you certify that you are requesting changes to an existing insurance policy, and that you are authorized to do so.*
Consent*
I understand that, except as provided by my current insurance policy, no coverage is bound until requested in writing and confirmed by an authorized agent.*
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Name*
First Last
Phone*
Email*
Company Name*
Effective Date of Change
MM slash DD slash YYYY
Last 4 Digits of Tax ID or SSN*
Description of Change*
I understand that, except as provided by my current insurance policy, no coverage is bound until requested in writing and confirmed by an authorized agent.*
- Yes, I understand.
Captcha

Making a payment

Aegis Insurance Company

Agency Insurance Company of Maryland (AIC)

AmTrust

Builders Mutual

Building Industry Insurance Association

Bristol West Insurance

CNA Insurance

Foremost Insurance

Hagerty Insurance

Harford Mutual

JC Taylor

Liberty Mutual Insurance

(Business Insurance)

Main Street America Insurance

(Personal Insurance)

Main Street America Insurance

(Business Insurance)

Philadelphia Insurance

Progressive Insurance

Safeco Insurance

Seneca Insurance

The Hartford

Travelers Insurance

(Personal Insurance)

Travelers Insurance

(Business Insurance)

Virginia Property Insurance Association

Wright Flood Insurance

Filing A Claim

Aegis Insurance Company

Agency Insurance Company of Maryland (AIC)

AmTrust

Builders Mutual

Building Industry Insurance Association

1-888-730-1572 x260

Bristol West Insurance

CNA Insurance

Foremost Insurance

Hagerty Insurance

Harford Mutual

JC Taylor

Liberty Mutual Insurance

(Business Insurance)

Main Street America Insurance

(Personal Insurance)

Main Street America INSURANCE

(Business Insurance)

Philadelphia Insurance

Progressive Insurance

For Glass Claims:

Safeco Insurance

Seneca Insurance

The Hartford

Travelers Insurance

(Personal Insurance)

Travelers Insurance

(Business Insurance)

Virginia Property Insurance Association

Wright Flood Insurance

Getting ID Cards

Do you need ID cards for your...*
- Personal Policies
- Business Policies
Business Name*
Owner's Name*
First Last
Name*
First Last
Cell Phone*
Email*

Requesting a Certificate of Insurance

Requests may need additional time, depending on additional forms requested. Delivery of certificates may take up to four business days. Please review the following information carefully.

Insured/Policy Holder's Information
Requestor's Name*
First Last
Email*
Company Name*
Work Phone Number*
Certificate Holder's Information
The Certificate Holder is NOT the Insured/Policy Holder. Usually the Certificate Holder is the business/entity or consumer the Insured/Policy Holder is performing services for. The Certificate Holder also could be a Landlord

NOTE: The Insured/Policy Holder understands adding an Additional Insured and/or Waiver of Subrogation by endorsement is subject to an additional charge by the insurance company
Certificate Holder's Name*
Certificate Holder's Email Address*
Certificate Holder's Address*
Street Address City State ZIP Code
Do you have a written contract with the Certificate Holder?*
- Yes
- No
Upload copy of Contract
Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 256 MB, Max. files: 10.
Does the Certificate Holder need to be listed as an additional insured?
- Yes
- No
Which policies?
- General Liability
- Business Auto
- Umbrella Liability
- Professional Liability
Does the Certificate Holder need a waiver of subrogation?
- Yes
- No
Which policies?
- General Liability
- Business Auto
- Workers' Compensation
- Umbrella Liability
- Professional Liability
Project Location
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Delivery Options
How Do You Want This Certificate To Be Issued To You?
- Mail
- E-mail
How Do You Want This Certificate To Be Issued To The Certificate Holder?
- Mail
- E-Mail
Authorization
The undersign hereby authorizes Perry Family Insurance Agency (Agency) to make necessary changes (if they exist) to my policy (ies) to reflect the changes I have made using this form effective the date below. To my knowledge, this information is accurate as of the date below. The undersign holds Agency, its agents, officers, and employees harmless from all errors and/or omissions should the information on this form be incorrect. Agency staff endeavors for 100% accuracy as much as humanly possible.
TERMS OF ACCEPTANCE and SIGNATURE*
I, the authorized representative, warrant the truthfulness of the information provided in this form.
- I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
Captcha

Let us find the Right Insurance for you

When the unexpected happens, we provide the right coverage to provide you some peace of mind. Request a quote to let us match you to the right coverage for your individual, or business needs.

Request a quote

independent insurance agency licensed in Virginia and Maryland

Perry Family Insurance Agency is a multi-line, multi-carrier independent insurance agency licensed in Virginia and Maryland. Our principal agents are highly experienced in all property/casualty and life insurance ensuring you have the right coverage for all your personal and business needs. All represented carriers carry an excellent or better rating with A.M. Best.

Call us at (804) 675-4300
10301 Hull Street Road
Office 3, Suite 3
Midlothian, VA 23112

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