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

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

How many years of similar experience does this driver have? *
Does this driver have any major violations or claims in the last five years?
Submission Validation

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