Update Insurance Policy

Provide your updated insurance info here!

1Personal Information

2Insurance Policy Information

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Last six digits of your Vehicle Identification No.

Last four digits of your Social Security No.

Company Name *

Company Phone

Do you have an Agent (ex. Estrella, Del Toro, etc...) *

Policy Number *

Effective Date

Expiration Date

Do you have Comprehensive Coverage? *

Do you have Collision Coverage? *

Additional Notes

Upload supporting documents? (ex. picture of insurance card or policy binder)

Disclaimer *

By signing below I Agree to all Term and Conditions of this request

I understand that the Retail Installment Sales Contract or Finance Contract or Lease Agreement (“Contract”) that I signed in connection with my account to the above-described vehicle requires me to provide and maintain insurance on the vehicle against the risks of loss or damage. I understand that this insurance must be in an amount equal to the lesser of the unpaid/capitalized amount due under the Contract or the value of the vehicle and must be maintained for the entire term of the Contract. I also understand that the holder of the Contract must be named as the loss payee and that the failure to maintain proper insurance coverage on the purchased Vehicle may be an event of a default under the Contract. In the event of a default, the holder of the Contract may pursue all of the remedies provided by law and in the Contract as it deems appropriate. Having been advised that I may obtain insurance coverage from a company and agent of my choice.

Lien Holder/Loss Payee Information
AmeriFinance, Inc.
P.O. Box 814853
Hollywood, FL 33021-4853

I further understand that if for any reason physical damage insurance is not obtained and continuously maintained, AmeriFinance, Inc. may, at its option, secure insurance for its own protection. I authorize AmeriFinance to add the premium and related finance charge for such insurance to my contract balance and understand that such insurance DOES NOT PROVIDE ME WITH BODILY INJURY OR PROPERTY DAMAGE LIABILITY INSURANCE COVERAGE, AND DOES NOT COMPLY WITH ANY NO FAULT INSURANCE OR FINANCIAL RESPONSIBILITY LAWS.

By signing below, I and/or We consent to AmeriFinance, Inc. using the information on the provided Credit Application to verify all applicable information in regards to the request for extending credit for the purchase or lease of a used vehicle, but not limited to access my and/or our credit report(s) from multiple credit reporting agencies, income, employment history and any other public records accessible to AmeriFinance, Inc. Furthermore, I and/or We consent to AmeriFinance, Inc. to share such information with any of its affiliates in an effort to secure the loan or lease agreement.

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