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Add/Delete Driver


Please fill out as much information as possible to speed up the process. If you are adding a driver and have a copy of his/her recent Motor Vehicle Report (sometimes referred as "driving record"), please fax it to (503) 387-5211 or via e-mail

Personal Information
First Name
Required
Last Name
Required
Business Name
Optional
Street
Required
City
Required
State
Required
ZIP / Postal Code
Required
Primary Phone Number
Required
Alternate Phone Number
Optional
E-Mail Address
Required
Policy Number
Required
Adding or Deleting Driver?
Required

Driver Information
Name of Driver (First, Last)
Required
Gender
Required
Date of Birth
Required
/ /
When will this change take effect?
Optional
/ /
License State
Required
License Number
Required
Does this driver have valid CDL (commercial driver's license)?
Required


How many years of similar experience does this driver have?
Required
Does this driver have any major violations or claims in the last five years?
Optional
Submission Validation
Required
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.












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 Licensed in: OR, WA, ID, NV, SC, NC, GA. CA license # 0I29732, Choice One Insurance Agency