Replace A Vehicle on Exisitng Policy
Contact Information
 
Current Auto Policy Number:
 
Name on Policy:
 
Your Name:
 
Email Address:
 
Daytime Telephone Number:
Vehicle Being Replaced:
 
Old Vehicle Make:
 
Old Vehicle Model:
 
Old Vehicle Year:
NEW VEHICLE INFORMATION
 
Effective Date of Policy Change:
(mm/dd/year)
 
VIN #:
 
Year of New Vehicle:
 
Make of New Vehicle:
 
Model of New Vehicle:
 
Is this a purchase or lease:
 Purchase
Lease
 
Body Type of New Vehicle:
 
Title Holder/Registered Owner:
 
Name of Principal Driver:
 
Principal Driver's Relationship to Named Insured:
 
Occasional Driver/Operator:
 
Purchase Price:
 
Lien Holder/Loss Payee Name:
 
Lien Holder Address:
 
Garage Address:
New Vehicle Desired Coverages:
 
Vehicle Useage:
(describe)
 
Miles to work (one way):
 
Deductibles:
 Comprehensive
 
 
 Collision
 
Anti-Lock Brakes:
 
Car Alarm:
 
Air Bags:
 
Rental Coverage:
 
Towing Coverage:
 
Additional Comments:

By submitting this form you understand that no coverage is bound until you receive written notice. Changes to policies via this website are not effective or binding until you, or any party involved, receive official notification from your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.
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Site Mailing List 
Serving Virginia For Over 140 Years!

PO Box 306
1404 South Main
Farmville, VA 23901
Phone: 434-392-5405
Email: info@harwoodins.com

 

 

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Community Involvement:

  • Board of Trustees, Hampden Sydney College 2000 – 2013
  • Board of Trustees Randolph-Macon Academy 2002 - 2004
  • Board of Directors, 1st National Bank of Farmville/1st Virginia Bank 1980-1995
  • Virginia Commission of State and Local Governments’ Responsibility and Taxing Authority 1995 – 1996*
  • Commission on the Future of Higher Education in Virginia*
  • Tobacco Indemnification and Community Revitalization Commission 2005 – 2009**
  • Chairman, Prince Edward County United Way, 1988
  • Chairman, Poplar Hill Community Development Authority 2000 – 2004
  • President, Randolph-Macon Academy Alumni Association 2002 – 2004
  • YMCA
  • Farmville Area Chamber of Commerce
  • Farmville Jaycees
  • Farmville Rotary Club
  • Mission work in Honduras
  • Farmville Lions Club
  • Farmville Masonic Lodge
  • Longwood College Center For the Visual Arts
  • Southside Virginia Red Cross
  • Active annually in state and federal lobbying for client and industry advocacy.
  • Veterans of Foreign Wars, Life member
  • Insurance Education for Habitat For Humanity Recipients

 

*Appointed by Governor George Allen
**Appointed by Governor Mark Warner