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Call: 478-474-6468
or 800-777-8316
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Allen and Lambert Insurance
1760 Bass Road Suite 101
Macon, Georgia 31210
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Phone: 478-474-6468
Fax: 478-474-0116
Toll Free: 800-777-8316
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     ADD VEHICLE

Add A Vehicle Request Form

Name:  
Address:  
City, State & Zip :  
E-Mail:  
Phone #:  
 Fax #:  
Name on Policy:  
Policy Number:  
Year:  
Make/Model:  
Lease/Purchase?
Driver Assigned:  
Registered to?:  
Cost:  
Vin #:  
Odometer:  
Lien Holder:  
Garage Address:  

Anti-Theft?:  

Vehicle Useage:  
Towing Coverage:
Comprehensive & Collision Deductible Amounts:  
Effective Date of Change:  


Additional Comments
Note: By submitting this form you understand that no coverage is bound until you receive written notice. You also agree to release us from any liability if this information is accidentally viewed by unauthorized persons. We will only use this information for insurance quoting purposes and not distribute to other parties.


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