Homeowners Policy Change Request

Please use the form below to notify us of any changes to your homeowners policy insured through Tompkins Insurance Agencies. Please note that this form is for notification purposes and any changes will not be binding until you receive confirmation from our agency. 

Disclaimer

I understand that my coverage (or changes in coverage) ARE NOT binding via this on-line request; Changes ARE considered binding when I receive an email (or fax) response from my agent indicating that they have received my request.

 I have read and agree with the above disclaimer.
    (Box must be checked before request can be sent)
Policy Holder Information
Name Insured:
Phone #:     E-Mail:
Effective Date of Change:
Please check nature of change:
Mortgagee Change
Increase/Decrease Limit of Insurance
Change of mailing address/phone number
Add endorsement
Other
Please DESCRIBE specifics of your request:
 
   

                                                                                                                                                             revised 08.04.08 BH