Kent Sutherland

Insurance Corporation




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Kent Sutherland

Insurance Corporation




DO NOT cancel other coverage until you have heard from your agency. 

Policy changes are not effective until you are notified by the agency that they have been completed. 

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I wish to make a change on the following:

Auto      Home     Renters     Life 


Policy # (if known)


Auto Changes:

Explain change requested:
Requested effective date:
New vehicle Year, Make, Model:
New vehicle VIN:
New vehicle existing damage:
New vehicle coverage limits:
Do you want "Full Glass" coverage?

Yes, I want "Full Glass"

Other changes:

Homeowner changes:
Renters changes:
Condo or Townhome changes:
Life Insurance changes:
Other changes:
Additional information: