Add or Remove a Driver to an Existing Policy Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly. Policy Holder Information First Name*Last Name*Street*City*State*Zip / Postal Code*Primary Phone Number*Alternate Phone NumberE-Mail Address* Policy Number*Current Insurance Provider:Add or Remove a Driver Information*Add a Driver - New Driver InformationRemove a Driver - Driver Information Add a Driver - New Driver Information Name of Driver (First, Last)*Gender*MaleFemaleMarital Status*SingleMarriedSeparatedDivorcedWidowedWhen will this change take effect?* Relationship*SpouseChildRelativeParentNon-RelativeLicense State*License Number*Date of Birth* Does this driver have any major violations (5yrs), accidents or minor violations (3yrs), comprehensive or collision claims (3yrs)?Not SureYesNo Remove a Driver Driver Information Name of Driver (First, Last):When will this change take effect?: DISCLAIMER: Any changes expressed over the internet can only be honored after Hughes, Brennan & Wirtz Insurance, Inc. has acknowledged the receipt of the change and after underwriting approval. Changes expressed in emails or messages are not bound automatically. All changes are subject to verification and underwriting approval. Customer Service hours at Hughes, Brennan & Wirtz Insurance, Inc. are Monday-Friday 8:00 AM - 5:00 PM. This iframe contains the logic required to handle AJAX powered Gravity Forms. Resource Menu File a Claim / Pay Online Certificate of Insurance Request Form Add / Remove a Driver Add / Remove Vehicle Address Change Auto I.D. Card Request Form Refer a Friend FAQs