ࡱ> EGD` ,bjbj 46",,,@$ $ $ $ \ @ ^ ^ ^ ^ = NTDFFFFFF$hjQ,9 = j^ ^    (8^ ,^ D D  , ^ V,,$ R D0 Tl , 80" jjL@@@$ @@@$ @@@ Vehicle Transfer Sheet Dear Automobile Dealership: In order to request a vehicle change, please complete this form and e-mail back to us as an attachment to  HYPERLINK "mailto:agency@pioneerinsurance.com" agency@pioneerinsurance.com or fax it to us at 910-944-6088. Upon receipt, we will promptly process the change request. If verification is required, please advise contact person and phone number. Customer Name:  FORMTEXT       Name on Title:  FORMTEXT       Vehicle to be deleted: Year:  FORMTEXT       Make:  FORMTEXT       Model: FORMTEXT       Vehicle to be added: Year:  FORMTEXT       Make:  FORMTEXT       Model: FORMTEXT       Serial #  FORMTEXT       Number of Doors: 2 FORMCHECKBOX  4 FORMCHECKBOX  Will the title be held by a loss payee? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Loss Payee Name:  FORMTEXT       Address:  FORMTEXT       City, ST Zip:  FORMTEXT       Comprehensive Deductible:  FORMTEXT       Collision Deductible:  FORMTEXT       Is the vehicle leased? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Additional Insured Name:  FORMTEXT       Address:  FORMTEXT       City, ST Zip  FORMTEXT       Cost New: $ FORMTEXT       Gross Vehicle Weight:  FORMTEXT       Safety Features  Number of Air Bags:  FORMTEXT       Auto Seat Belts: Yes FORMCHECKBOX  No FORMCHECKBOX  Type of Alarm System: Passive FORMCAYy 0 , . 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PO Box 941, Southern Pines, NC 28388-0941 Phone: 910-944-2848 Fax: 910-944-6088 agency@pioneerinsurance.com r()))d***P++++J,,,,,,$a$gdKJgd;jgd Txgd T(x$d%d&d'dNOPQgdKJ&$d%d&d'dNOPQgdKJ))@)D)F)Z)\)^)h)j)n))))))))))))*****$*&*<*>*R*޶ެ޶ގlX&jh ,OJQJU^JmHnHu'j}h ,h TOJQJU^Jjh ,OJQJU^Jh;jOJQJ^J'jh_h8hOJQJU^Jh TOJQJ^J&jh_OJQJU^JmHnHu'jh_h8hOJQJU^Jjh_OJQJU^Jh ,OJQJ^Jh_OJQJ^JR*T*V*`*b*d***************** +"+$+&+:+<+>+ݿݵݵݵݿyoyayMa'jUhH hH OJQJU^JjhH OJQJU^Jh_OJQJ^JhH OJQJ^Jh TOJQJ^J'jh ,h TOJQJU^J'jih ,h TOJQJU^Jh ,OJQJ^JhKJOJQJ^J&jh ,OJQJU^JmHnHujh ,OJQJU^J'jh ,h TOJQJU^J>+H+J+P+Z+\+^+r+t+v++++++,,,,ʢh8hh;j#hKJhKJ5CJOJQJ^JaJhKJOJQJ^J'jhH hH OJQJU^JhH OJQJ^Jh ,OJQJ^Jh_OJQJ^JjhH OJQJU^J&jhH OJQJU^JmHnHu21h:p T/ =!"#`$`% DyK agency@pioneerinsurance.comyK Fmailto:agency@pioneerinsurance.comtDText1tDText2tDText3tDText4tDText5vDText19tDText6tDText7tDText8tDeCheck1tDeCheck2tDeCheck3tDeCheck4tDText9vDText10vDText11vDText13vDText28tDeCheck5tDeCheck6vDText20vDText21vDText22vDText15vDText23vDText16tDeCheck9vDeCheck10vDeCheck11vDeCheck12vDeCheck13vDeCheck14vDeCheck15vDeCheck16DText17M/d/yyyyxDText180vDText24vDText27vDText25vDText26vDText29DPText30M/d/yyyy@@@ NormalCJ_HaJmH sH tH DA@D Default Paragraph FontRiR  Table Normal4 l4a (k(No List6U@6 ;j Hyperlink >*B*ph%%645GT{\>,-^"#&00000000000000000000000000000000000000(/ B r l (^)R*>+, r(, ,  $*3?Ebnt}-=BRgsy5EJZv>JPgw&,<Xdj$*HTZdpv%XFFFFFFFFFG$G$G$G$FFFFFG$G$FFFFFFG$G$G$G$G$G$G$G$FFFFFFFF8@0(  B S  ?%*Text1Text2Text3Text4Text5Text19Text6Text7Text8Check1Check2Check3Check4Text9Text10Text11Text13Text28Check5Check6Text20Text21Text22Text15Text23Text16Check9Check10Check11Check12Check13Check14Check15Check16Text17Text18Text24Text27Text25Text26Text29Text304b~.Ch6Kw?h-XId&  !"#$%&'()+Fu>SzF[Qx'=k +[w&8P 8P 8P \!&!&:*urn:schemas-microsoft-com:office:smarttagsStreet;*urn:schemas-microsoft-com:office:smarttagsaddress>*urn:schemas-microsoft-com:office:smarttags PersonName 4Z/qx~"&5-H[dw"#&3buTefg{v>Vlmy|+,-<<G[]]^!&>-H[dw"&8h;jPG , TH _KJ@H/L%P@P P PPP(UnknownGz Times New Roman5Symbol3& z Arial"qh-2&;FK2&266#`42HX ?;j2Vehicle Transfer SheetTeresa B. BeykeTeresa B. BeykeOh+'0  $0 P \ h tVehicle Transfer SheetTeresa B. BeykeNormalTeresa B. Beyke5Microsoft Office Word@#@Z/+@>++@@,,6՜.+,D՜.+,X hp  Applied Systems, Inc. Vehicle Transfer Sheet Title 8@ _PID_HLINKSAjJ#mailto:agency@pioneerinsurance.com  !"#$%&()*+,-./012356789:;=>?@ABCFRoot Entry F~V,,HData Q1Table'WordDocument46SummaryInformation(4DocumentSummaryInformation8<CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q