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Vehicle Identification
Vehicle Identification fields marked with * are required and fields marked with ** are required only if adding vehicles (Add is chosen in Policy Change field). As an alternative, you may also download this form in an adobe document format, fill it out, and either fax it to (916)774-7040 or email it to the Member Services Department.
Vehicle Information
* Policy Change
* District
** Date Aquired  
('mm/dd/yyyy' format only)
Unit Number
* Vehicle Year * Vehicle Make
* Vehicle Model * Vehicle Type
* Vehicle Identification Number (VIN) ** Estimated Value
Please include all modifications $5,000 or greater. Including, but not limited to, adding a Crane, a Spray Rig, Body Customizations, or any other enhancements or after market items added to the vehicle.
Modifications
** Lease or Financed
Contact Information
* First Name * Last Name
* Email
  
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