Junked Vehicle

IMPORTANT: READ THIS COMPLETELY

After you complete the information listed below, we will return a completed document to you via e-mail for an electronic signature. We utilize e-Signlive.com to process electronic signatures. You should receive a notification requesting a signature from e-Signlive within two work days. If you do not see a notification, you may wish to check your 'spam' folder in case the e-mail was flagged.

Email*

Name*

Telephone Number*

License Plate/KY Number*

VIN*

Year of Vehicle*

Make of Vehicle*

Model of Vehicle*

IF THE VEHICLE WAS JUNKED
One of the following pieces of documentation is required:
- Copy of the title signed front and back
- Receipt from junkyard
- letter from your insurance company that includes the year, make, model, VIN, and the date the vehicle was deleted from your policy.

Name of Junkyard

Date Vehicle is junked

PLEASE UPLOAD YOUR REQUIRED DOCUMENTATION HERE

File Attachments*

Mailing Address*