Commercial Insurance change of address request

Lewis Insurance Associates now offers you the ability to make changes to your existing commercial account online using the form below.

( * indicates required information)

*Effective Date of change:	Mo. Day Year
*Business Name:
*Contact Person:
*Phone Number:
*E-mail address:
*Policy Number :
Fax Number:
*Current Mailing Address:
*City:
*State:
*Zip:
New Mailing Address:
Physical Garaging Address:
Do you have any other policies that need an address change?	Fivestar/Contractor Ultrapack Ultraflex General Liability	Auto/Garage Worker's Compensation BCL Other:

I understand that NO changes to my policy or coverage are bound by submitting this online Policy Change Request. This Change request will be considered bound ONLY upon confirmation from my LIA agent. I have read and agree with the above. (Box must be checked before request is sent)