The Hanks Group - Loss Payee Change

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Loss Payee Change

Add or Delete Loss Payee/Mortgagee

Contact Information

Policy Number Affected By Change:
Name on Policy:
Your Name:
Email Address:
Daytime Telephone Number:

Loss Payee/Mortgagee Information

Effective Date of Policy Change: (mm/dd/year)
This Change Applies To My:
Loss Payee/MTG Name:
Loss Payee/MTG Address:
ADD or DELETE Above Loss Payee/MTG:	ADD DELETE Loss Payee Loss Payee

If change is for a vehicle, please specify below

Year of Vehicle:
Make of Vehicle:
Model of Vehicle:
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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The Hanks Group
8238 E. RL Thornton Fwy Suite D
Dallas, TX 75228

Toll Free: 877-275-8372
Phone: 214-275-8372 fax: 214-275-8375
email: info@hanksgroup.com

� Copyright 2006
IMPORTANT NOTE: descriptions of insurance coverage on this web site are for informational purposes only and may not apply, or be included on your policy. Please contact us to confirm coverage provided on your insurance policy or policies your are contemplating purchasing. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.
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