Add a Driver If you’re needing to add an additional driver to your existing policy, simply fill out the form below and we’ll get in touch with you to confirm the amendment. Name First & Last Name of Policy Holder * Policy Number * Effective Date * Email Address * Phone Number * Preferred Method of Contact * Email Phone New Driver First & Last Name * Driver's License Number * State of Issue * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming New Driver's Date of Birth * New Driver Relationship * Spouse Child Parent Other New Driver Primary Operator of Vehicle * Yes No Miles Driven One Way to Work/School * If the new driver is a student, did they earn a at least a 'B' average on their most recent report card? * Yes No Comments Agreement: I understand that no coverage is effective until I receive confirmation from a representative of Willow Insurance Agencies, LLC or from my insurance carrier. Privacy Policy * Coverage on your policy cannot be bound only by filling this form. Only after you confirm the information with one of your team members will the changes go into effect.
