South Hill Insurance

Live Support

South Hill Insurance
P.O. Box 732127
South Hill, WA 98373

Phone: 888-307-1519
Toll Free: 888-307-1519
Fax: 888-307-1519

Hours of Operation:
Mon - Fri 8:30AM to 4:30PM
Saturday - By Appointment
Sunday - Closed

Map and Directions
To Our Office >>>

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Insurance Glossary

Customer Service & Support

Customer Service Center

Customer Service Center - Home

Step 1 - How can we help you?
Send A Message - Ask A Question - Make A Change - Report A Claim - Request Documents - Billing & Payment Information

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For Agency Phone, Fax, Email, Map, Directions or Hours of Operations - Contact Us

Step 2 - Company and Policy Information

Insurance Company *

Type of Policy *

Policy Number (If Known)

Requested Effective Date (Changes/Docs)

Step 3 - Customer and Contact Information

Named Insured (As Shown On Policy) *

Your Name (First and Last) *

Are you the insured? *

If No, Relation

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Your Email *

Your Phone (xxx-xxx-xxxx) *

Your Fax (xxx-xxx-xxxx) or NA *

Step 4 - Describe Request, What Caused the Request and Then Click Continue >>>

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Customer Service Center - Change of Agent / Broker of Record

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If you wish to have our agency take over the servicing of an existing policy please copy and paste the letter below (between the lines) to your company letterhead. If individual policies, please enter your Name, Address, City, State and Zip. Please note to replace date and list insurance companies and policy numbers you wish to have us assume. Once completed and signed, mail or fax the form to us as indicated in our contact page.

(FOR BUSINESS PLACE THE LETTER ON YOUR LETTER HEAD
--OR--
FOR INDIVIDUALS PLEASE ENTER

NAME
ADDRESS
CITY, STATE. ZIP)

(DATE)

RE: Appointment of (AGENCY NAME) as our Agent/Broker of Record

To Whom it May Concern:

This will confirm that we have appointed Micciche Insurance as our exclusive insurance agent/broker of record for the following policies

1. (COMPANY) - Policy #:
2. (COMPANY) - Policy #:
3. (COMPANY) - Policy #:

The appointment of (AGENCYNAME) rescinds all previous appointments and the authority contained herein shall remain in force until canceled by us in writing.

This letter also constitutes your authority to furnish (AGENCY NAME) representative with all information they may request as it pertains to our insurance contracts, rates, reserves, retention, and all other financial data they may wish to obtain for their study of our present and future requirements in connection with our insurance policies.

Sincerely,

(NAME)
(COMPANY / INDIVIDUAL NAME)
(TITLE, IF APPLICABLE)

Please Continue For Tracking Purposes

We respectfully request once you have copied the information above and are preparing to submit to us that you click below to complete this submission so that we can monitor for the documents to arrive in our agency.

Customer Service Center - Terms of Use and Complete Request

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Final Comments or Remarks

TERMS OF USE --- Important, Please Read

Submission of this information does not guarantee coverage. Additional information may be required to complete your request. No coverage is bound until approved by an authorized representative and your are contacted by an authorized representative or you receive confirming documents such as the issued policy, certificate of insurance or an insurance binder. Submit information for only one policy, submit a separate request for additional policies. Requested effective dates are subject to approval based on policy guidelines. Unless provided by policy language, retro-active or back-dated requested effective dates will not be honored.

You must enter your initials and click "I Agree" below or your submission will not be processed. By entering your initials and clicking "I Agree" you are confirming you have read and agree to the "TERMS OF USE" above.

Upon valid submission you will receive a confirmation of your request at the email below.

Confirm Email & Enter Initials

Enter Initials

Customer Service Center - Policy Cancellation

Please enter the requested effective date and reason for cancellation below. Once entered, further instructions will appear below the reason for cancellation.

Requested Cancellation Date

Reason for Cancellation

Remarks

Cancellation Instructions - Important

To process your cancellation request as timely as possible we request that you follow these two steps. First, you must submit a signed request to cancel a policy, second you must complete this submission.

To access the cancellation request form you will click the "Request Cancellation Form" link below. Print the form and sign it in the "Policy Release Statement" section on the "Signature of Named Insured" line. Once signed please fax (email or mail) the form to us.

Once you have accessed and printed the form then click the "Continue >>>" button below and complete this submission. This will alert us that a signed cancellation form is forth coming and will be completed using the data provided on this submission.

Click here for "Request Cancellation Form"

Customer Service Center - Request/Schedule Call Back or Appointment

I am requesting the following:

	Call Back As Soon As Possible
	Schedule Call
	Schedule Appointment

Regarding

My Name (First Last)

Primary Phone Number

Secondary Phone Number

Scheduled Call or Appointment

If requesting a scheduled call or appointment, please list two date and time options. You will receive a confirming email with availability of your choice(s).

Preferred Date & Time

Secondary Date & Time

Scheduled appointments are to be held in our office. I you would like to meet at your home, business or other location please indicated in remarks.

Remarks

Service Center - Property Claim

Please provide a general narrative, description, circumstances and damages of the claim.

Date & Time of Loss

Location of Loss

Cause of Loss (If other describe above)

Police or Fire Dept To Which Reported

Policy/Fire Report Number if Applicable

Estimated Amount of Entire Loss

Customer Service Center - Auto / Motor Vehicle Claim

Date & Time of Accident

Description Of Accident

Location of Accident (address or cross streets) Include City and State

Authority Contacted (Policy/Sheriff Dept Name)

Report # (If Applicable)

Ticket Issued? Which Driver?

Insured Vehicle - Year, Make, Model, License Plate # & State and Describe Damage

Driver Name & Address, Relationship To Insured, Date of Birth and Drivers License Number.

Other Driver and Other Property Damaged (Vehicle and/or Property)

Other Driver Name, Address and Phone Number and(Owner Name, Address & Phone if different)

Describe Property, Damage and Estimate Amount - (If auto - year, make, model and plate #)

Describe Any Injuries and List Any Witnesses

If any injuries, list name, address, phone number, which vehicle or pedistrian, extent of injury and facility transported to.

Witnesses or Passengers - Name, Address, Phone Number and which vehicle if applicable.

Customer Service Center - Liability Claim

Date & Time of Loss

Location of Occurrence (Include City/St.)

Police/Fire Dept Contact & Report #

Description of the Occurrence - Claim

Type of Liability - Premises - Product(s) - Completed Operations - Other Liability

Premises: Insured Is -

Type Of Premises

Owner's (If Not Insured) Name, Adddress and Phone Number

Products: Insured Is -

Type of Product

Manufacturer's (If Not Insured) Name, Address and Phone Number

Other Liability Including Completed Operations (Explain)

Injuries and/or Property Damaged

Injured - Name, Address, Phone, Age, Sex, Occupation and Employer (Name & Address)

Injured - What were injured doing? Describe injuries and indicate where they were taken.

If Property Damaged - Describe property, where and when can property be seen and estimate amount of damage.

Witness Information

Please enter the name, address, and contact phone numbers for any witnesses.

Customer Service Center - Workers Compensation
Claim - First Report of Injury or Illness

Employee Information

Employee Name (Last, First, Middle)

Employee Address

Phone

Employee Date of Birth (mm/dd/yyyy)

Occupation/Title:

Date of Hire (mm/dd/yyyy)

Employment Status

Occurrence Information and Treatment

Date & Time Employee Started Work

Date & Time of Occurrence

Date & Time Employer Notified

Where did Accident/Illness Occur

Describe Accident or Illness

Was Safety Equipment Available?

Was it Used?

Describe in detail what activity the employee was engaged in, any equipment, materials or chemicals exposed to, or work process employee was engaged in.

Witnesses - If any witnesses enter name and contact information.

Customer Service Center - Vehicle Changes

Type Of Vehicle Change

If Replacing or Deleting Vehicle(s) - Enter Year, Make and Model of each vehicle to be REMOVED from policy

Park A Vehicle

Note: If deleting a vehicle because it is going to be parked and not used (Example - Child has gone to college and 3rd vehicle will not be used or vehicle is garaged for six months as you "winter" out of state) rather than removing the vehicle you may be eligible to change coverage to "Comprehensive Only"

"Comprehensive Only" will protect from damage for losses other than collision such as theft or vandalism. If you would like to see if you qualify for this coverage enter "COMP ONLY" along with Year/Make/Model and why the vehicle will not be used in the Replace/Delete field above.

Add Vehicle

Year (yyyy)

Make-Model-Body

Vehicle Identification Number (VIN)

Primary Driver

Garaging Zip Code

Miles One Way To Work/School

Used For Business?

Coverage Changes

Does this change require any change of coverage? For example replacing an older vehicle that is paid off with a new vehicle that is financed and will require comprehensive and collision coverage. If left blank, vehicle will be added with the highest coverage afforded any vehicle on the current policy, or if "Replacing A Vehicle" the new vehicle will default to the coverage provided for the prior vehicle. Describe Coverage Changes Below:

Vehicle over 25 Years Old - Classic/Antique Auto
NOTE - Vehicles over 25 years old may not qualify for full coverage under the standard auto policy but may be available for classic or antique programs depending on condition or level of restoration. Please contact the agency directly to review options.

Is Vehicle Financed or Leased?

Interest Type

Note - A newly financed or leased vehicle may require certain liability limits (such as 100/300 or 300CSL) or minimum deductibles (such as 100 Comprehensive 250 Collision). If your finance / lease contract requires certain coverage, limits or maximum deductibles indicate above in "Coverage Changes"

Important - If vehicle has recently been purchased and is financed/leased make sure you provide the Additional Interest/Loss Payee (Your Lender) information below. If the information is not provided, or mailing address is incorrect, the lender/lessor will not receive proof of insurance and they may add mandatory insurance to your loan which will increase your monthly payment.

Additional Interest Information - Lender
Enter the name, address, and loan number of the lender below so that a copy of the policy can be provided to them. This field is not required to continue processing a vehicle change, however if financed/leased we encourage you to provide the lender information as soon as possible or complete the Dealership contact info below so that proof of insurance can be sent.

If you would like assistance in verifying the contact and address information for the lender, enter the Dealership, Phone Number and Contact Person(if known) vehicle was purchased from.

Dealership, Phone & Contact Person

Customer Service Center - Driver Changes

Type Of Driver Change

Enter Drivers First and Last Name, Date or Birth or Age to be Removed or Replaced

Add Driver

Name (As Appears On License)

Sex

Drivers License Number

Marital Status

Date of Birth

Years Licensed

Primarily Drives Vehicle (YR/Make/Model)

Occupation

Social Security Number

Note: List all tickets and accidents (whether at fault or not) below.

Any Tickets / Accidents Last 3 Years

If yes, enter date and type of violation or description of accident.

Customer Service Center - Location Change

Use this location change section to add-replace-delete locations that are/or to be provided coverage for buildings, contents or both or for additional garaging locations. For primary policy physical or mailing address changes click the <<< Back button and use "Change of Address" section.

Type of Location Change

Delete Location
Enter the address, city, state and zip of location to be deleted and why it is being removed.

Add Location
Check All Location Options That Apply:

Garaging Location

Building Coverage Requested

Contents Coverage Requested

Building Coverage $

Contents Coverage $

Your Interest

Year Built

Location Details - Address, City, State Zip - also indicate if this is an additional building at a current location.

Part Occupied

AGENCY LICENSE # XXXXXX

Note: Per our "Terms of Service" (TOS) agreement, descriptions of insurance coverage on this site are for informational purposes only and may not apply, or be included on your policy. Please contact us to confirm coverage provided on your insurance policy or policies your are contemplating purchasing.