Personal Automobile Coverage Suspension Request Form

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  • What is your first name?
  • What is your last name?
  • What is your email address?
  • You are requesting to suspend coverage on your automobile policy to reduce your premium. Once this change is processed you will not have coverage for any claims if the vehicle(s) with coverage suspended is/are driven.
  • Enter the vehicle(s) from which you would like to remove coverage?
    YearMakeModel 
  • Please select the coverage(s) you would like to remove while the vehicle(s) are not in use.
  • What date would you like to have coverage removed?
    MM slash DD slash YYYY
  • Coverage will remain suspended until you notify us that you would like coverage reinstated. Vehicles with coverage suspended should not be driven until coverage is reinstated.
  • Please sign in the space below.
    Clear Signature
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Life can be complicated but protecting the things that matter doesn’t have to be. For more than 120 years, Avery has been a trusted insurance source for families and businesses alike. By using a consultative approach we uncover areas of vulnerability so our clients can sleep at night. We will take the time to get to know you and build a comprehensive portfolio of asset protection unique to you. If you’re looking for a partner to help protect what matters most in this wonderful journey we call life, you’ve come to the right place.

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