Bizurance - Where Business Goes for Insurance

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Personal Insurance Change Request

First Name

Last Name

Policy Number

Effective Date of Change



Check what type of policy you would like change made on











Requesting to





Description of Change


Important Notice

Bizurance cannot bind, modify or cancel coverage via submissions to our website or by messages sent through e-mail. Completion and submission of this form or e-mail does not constitute either a binder or an application for insurance.  Changes to policies are not effective or binding until you or any party involved receive official notice from either a Bizurance representative or your insurance company.  If you have any questions, please feel free to Contact Us.