Please download the form and follow the instructions below. You must complete and fax the contract to us in order to have your car insured.

Here are the areas of the contract where you need to complete:

• Page 1 – Please fill in the blanks in the first paragraph. (Date = beginning date of policy)

• Page 3 – Sign under “LESSOR”.

• Page 4 (Schedule A) – VERY IMPORTANT – Please fill out this form to the best of your ability. The items that must be filled out are the make, year, model (example: Mitsubishi Mirage), and VIN#. Without this information, we cannot add your car to the policy.

• Page 5 (Sublease) – Page 1 – Fill in your name as the “Sublessor”. You must fill in your address.

• Page 8 – Sign under “SUBLESSEE”.

• Page 9 (Schedule B) –You must sign again under “SUBLESSEE”.

• Page 10 Bank Draft Authorization Form – This allows CHL to draft your banking account for your insurance premiums each month. Sign next to “Customer Signature” and attach a copy of a voided check. We will fill out the rest of the form for you. Please note that you cannot be insured without the bank draft form.

Please call us if you have additional questions. We are here to help!

Click here for the form
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