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Correira Insurance Agency, Inc.
 Change of Name 
Existing Policy: Change of Name

Contact Information
Your Full Name:
(as listed on policy now)
Your Email Address:
Daytime Telephone Number:
Policy Number:
Change Request
Your FORMER Name:
Your NEW Name:
Reason for Name Change:
Additional Comments:
Questions:

By submitting this form you understand that no coverage is bound until you receive written notice. Changes to policies via this website are not effective or binding until you, or any party involved, receive official notification from your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

123 Broadway Taunton, MA 02780

Phone: 508-822-2999

HOURS:

Mon.- Fri. 8 to 5

Sat. 9 - 12

Remember to make a copy of your auto  registration. If you loose the original you will save $25 for a copy at the registry.

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