Lappan Agency Inc.
Property Policy Change
(Existing Policy)
Name as listed on policy:
Please enter your email address:
Policy Number:
Daytime Telephone Number:
Your Name:
Change Request
Effective Date of Policy Change:
(mm/dd/yy):
Nature of Change:
Select...
Increase Limits
Decrease Limits
Add Scheduled Items
Remove Scheduled Items
Add Endorsement
Remove Endorsement
Other
(Select all that apply; use CTRL-click to select)
If Other, Please Specify:
Description of the Changes You Wish To Make: :