Wilson Insurance and Financial Planning, Hank Wilson, CFP

Wilson Insurance Agency
Independent insurance advisory services delivered remotely throughout Pennsylvania and licensed states nationwide.

We believe clients and agencies alike benefit from working with experienced professionals who operate with integrity, clarity, and regulatory awareness. We encourage consultation with licensed insurance and financial professionals holding recognized industry designations such as CFP®, ChFC®, CLU®, AAI, or equivalent credentials.

Professional oversight, advisory, and insurance services provided in accordance with applicable state regulations.

Responsible Producer and Remote Fractional Compliance Principal

Trusted Choice


Disclaimer: I understand that my coverage (or changes in coverage) ARE NOT binding via this on-line request; Changes ARE considered binding when I receive an email (or fax) response from my agent indicating that they have received my request.
	I have read and agree with the above (Box must be checked before request can be sent)

Policy Holder Information:
» Name Insured:
» Phone Number:
» Email:
Policy Number:
» Effective Date of Change:

If Adding a Vehicle:
Year:
Make:
Model:
Cost:
Anti-Lock Brakes:	Yes No
Air Bags:	None Driver Driver/Passenger
Anti-Theft Device:	Yes No
How will car be driven? (Check One):	Farm To/From Work In Business Car Pool Pleasure
Miles One Way to Work:
Primary Driver:
Relationship to Insured:
Age:
Defensive Driving Certificate?	Yes No
Drivers Training Certificate?	Yes No
Comp Coverage?	Yes No
Coll Coverage?	Yes No
Towing?	Yes No
Rental?	Yes No

If Deleting a Vehicle:
Effective Date of Change:
Year:
Make:
Model:

If Deleting a Driver:
Name:
Reason:

Auto Policy Change Request