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Client Service Request

Client Service Request Form

Policy Service Form Request, for Insured’s/Active Clients.

"*" indicates required fields

Thank you for Contacting Valley Trucking Insurance!

How May We Help You?*

Request a Certificate of Insurance

Request a Change

Make a Payment

File a Claim

Owner/Insured's Full Name*

First Last

Legal Business Name*

Your Phone Number*

Your Email for the Request Confirmation*

Please Select Which Option Fits Your Needs*

Progressive Insurance- https://www.foragentsonly.com/login/

Great West Casualty – https://portal.gwccnet.com/

Berkshire Hathaway – https://www.bhhc.com/

IPFS – https://www.ipfs.com/

Payment to Agency https://alllinesinsure.epaypolicy.com/

Other Insurance and/or Financing Company

What Change(es) Would You Like to Request?*

Add/Remove Driver

Add/Remove Truck or Trailer

Update Contact Information

Update Billing Information

Cancel your Insurance Policy 🙁

Other

Please Indicate*

What Would You Like to Update?*

Phone Number

Email

Address(es)

Business Name or Entity Change

New Updated Business Name*

Select Which Addresses You Would Like to Update*

Business Mailing

Business Physical

Business Equipment Garaging

Updated Mailing Address*

Street Address Address Line 2 City State ZIP Code

Updated Business Physical Address*

Street Address Address Line 2 City State ZIP Code

Updated Equipment Garaging Address*

Street Address Address Line 2 City State ZIP Code

What Date Would You Like This Change To Be Effective?*

Driver Changes*

Add Driver

Remove Driver

Add Driver*

First Name

Last Name

Date of Birth

Driver's License State

Driver's License Number

CDL Years of Experience (If Any)

CDL Class (If Any)

Remove Driver*

First Name

Last Name

Add/Remove Truck(s) or Trailer(s)*

Add or Remove

Year

Make

Model

VIN

Value

Owned, Leased, or Rented?

Lienholder/Loss Payee (If Applicable)

If you are requesting to remove a vehicle, please send a copy of a Bill of Sale, or a Lease Termination, of that vehicle. Required by Insurance Companies if your policy requires/has Insurance Filings.

Updated Phone Number*

Updated Email*

Enter Email Confirm Email

Billing and Payments

Select the Type of Payment Method*

Debit/Credit Card

Bank Account

Update Billing Information*

Cardholder Name

Credit/Debit Card Number

Expiration Date

CVV #

Billing address: If Different Than What We Have On File

Update Billing Information*

Bank Account Holder's Name

Account Number

Routing Number

We are Sorry to See you Go!

Please Note: If You Have Federal Insurance Filings, They Will Require 35 Days Minimum to Cancel the Insurance Policy, Unless You Can Provide a Declarations Page of the Replacement Insurance Policy, or Proof of Authority Revocation.

What Date Would You Like Us To Cancel Your Insurance Policy?*

*We Will Send you a Cancellation Form (LPR) with this Date to Your Email for E-Signature*

Upload Your Replacement Insurance Policy Declaration's Page

Max. file size: 98 MB.

Filing a Claim

Common Insurance Carrier Protocol and Expectation, is to Report the Claim Directly to the Insurance Carrier as SOON as Possible, Ideally Within 24 Hours After the Claim. You May Complete the Below Data Fields, to Document and Assist Your Business, as Well as Our Agency, Throughout the Claims Process.

Section 1 / 3*

Date of Loss

Time of Day of Loss

Your Vehicle That Was Involved

Location (Exact as Possible, Including Mile Marker, Intersection, ETC.)

Section 1 / 3

Section 2 / 3*

Point of Impact: (Describe Where the Damage is On Your Vehicle First, Then the Other Parties Vehicle) **EX: IV collided with CV in intersection, POI: IV front drivers fender to CV front of vehicle)

Section 2 / 3

Section 3 / 3*

Police/Fire Report Filed? Yes or No. If Yes, Indicate Which Report and the Report Number

Any Violations/Tickets Issued, and To Whom?

Is Your Vehicle Still Drivable? (NOT DRIVABLE IF LEGAL LIGHTS DAMAGED: EX: Headlights at Night, Brake Lights) If Not Drivable, What Is It's Current Location? (Side of Road, Tow Yard, ETC)

Section 3 /3

Please Provide As Many Details For The Loss As Possible*

Upload/Attach Any Photos of the Scene/Damages

Max. file size: 98 MB.

Request a Certificate of Insurance

Insured’s/Policy Holder’s Are Always Copied on Certificate Requests

Certificate Holder's Name*

Certificate Holder's Email*

Enter Email Confirm Email

Certificate Holder's Address*

Street Address Address Line 2 City State ZIP Code

Certificate Holder's Additional Requests

Make Certificate Holder an Additional Insured

Make Certificate Holder a Loss Payee

Include Vehicle Schedule

Include Driver Schedule

Other Specific Request

Please Indicate*

Thank you!

Please Agree to Statement*

I Understand That This Submission Is a Request, Not a Confirmation of Processed Changes. No Requests Have Been Processed Until a Licensed Producer Completes the Request.

Smarter Coverage. Real Support. No Hassle.

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1-509-795-1300 | help@valleytruckinginsurance.com

6406 N Monroe St, Spokane, WA 99208

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