Schmutter Strull Fleisch Inc., New York, NY 10011

Vehicle Insurance
Customer Service Request

Please complete the form below. We will contact you for any additional information required to complete your request. Please note that no changes to your policy will take effect until you receive a confirmation from us.

Please note that fields with an asterisk (*) are required.


I. Please identify yourself
	Name*

	Company

	Phone*

	Email*

	Insurance Co.*

	Policy #

	Vehicle use	CommercialPersonal




II. If Adding a Vehicle
	Year/Make/Model

	VIN

	Cost New

	Comprehensive/ Deductible

	Transfer Plates	YesNo




III. If Deleting a Vehicle Note: You must submit FS-6 to us if your vehicle is registered in NY before cancellation can take effect.
	Effective Date of Delete	/ /

	Year/Make/Model

	VIN




IV. If Adding a Driver
	Name

	Relationship to Insured

	Date of Birth

	Driver License #

	Driver Defensive Driving	YesNo

	Driver Training Certificate	YesNo




V. Comments



I understand that no changes to my policy will take effect until you review this request and I receive a confirmation that coverage changes are in effect.