Change of Ownership Form

Subroclaims # *

Your Name *

First

Last

Your Address

Address Line 1

Address Line 2

City

State

Zip Code

Your Email *

Your Phone

Vehicle Information

Sold Vehicle *

*

Date of Sale *

Sale Price *

Method of Payment *

Cash
Check
Other

Other Payment Method

Please specify other Payment Method

Documentation

Release of Liability

Click or drag a file to this area to upload.

Please upload a picture of your Release of Liability you filed with DMV

Bill of Sale

Click or drag a file to this area to upload.

Please upload a picture of your Bill of Sale showing buyer, sale date and sale price.

Communications related to sale

Emails related to sale

Click or drag a file to this area to upload.

Drag Outlook emails directly to this area. You can also take screenshots of emails/SMS messages and upload here.

Email/SMS Messages

Email or SMS text

App used to effect sale *

Insurance Policy Cancellation

Click or drag a file to this area to upload.

Drag Outlook emails directly to this area. jpg and pdf files are are also acceptable.

Party Vehicle was sold to

Buyer's Name *

First

Last

Buyer's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Buyer's Email

Buyer's Phone

The vehicle was sold to: *

3rd party
Family member
Friend
Associate

Additional comments