Customer Name* First Last Account Number*Insurance Company*Insurance AgentInsurance Contact NumberPolicy / Binder Number*Policy Term (months)Select123456789101112Please be advised that SAFCO requires a minimum 6 month policy. Contact your insurance company to update your policy.Effective Date Date Format: MM slash DD slash YYYY Expiration Date Date Format: MM slash DD slash YYYY Comprehensive DeductiblePlease enter a number from 0 to 10000.Please be advised that SAFCO requires a maximum deductible of $1,000. Contact your insurance company to update your policy.Collision DeductiblePlease enter a number from 0 to 10000.Please be advised that SAFCO requires a maximum deductible of $1,000. Contact your insurance company to update your policy.Is SAFCO listed as the loss payee on my policy?YesNoPlease be advised that SAFCO must be listed as the loss payee or lienholder. Contact your insurance company to update your policy.Upload Copy of your Insurance PolicyAccepted file types: pdf, doc, docx, jpg, gif, png.You may also fax a copy of your insurance policy to 1-866-319-1597. Be sure to include your name and account number on the fax, and call back to confirm receipt at 1-800-998-0763.