Add a Driver to an Existing Auto Policy

Fill out the following form as completely as possible. Once you have completed the form, select submit to send your information. Your request will be handled promptly.

Personal Information

First Name *

Last Name *

Street *

City *

State *

ZIP Code *

Email *

Primary Phone *

Alternate Phone

Policy Number *

Current Insurance Provider

New Driver Information

Name of Driver (First Last) *

Gender *

Marital Status *

When will this change take effect? (mm/dd/yy) *

Relationship *

License State *

License Number *

Date of Birth (mm/dd/yy) *

Does this driver have any major violations (5 yrs), accidents or minor violations (3yrs), comprehensive or collision claims (3 yrs)? *

Please choose

Add a Driver to an Existing Auto Policy

Personal Information

New Driver Information

Does this driver have any major violations (5 yrs), accidents or minor violations (3yrs), comprehensive or collision claims (3 yrs)? *

You are now leaving the UHCU site.