Dealer ID Card Request Form - Empire Insurance Agency

PLEASE NOTE: We monitor this online request during business hours. Typically we are able to respond within 60 minutes if we are able to confirm coverage.

There may be occasions where we are not available during normal business hours. We ask that you always fill out this form as the first step in obtaining an ID card.

Submit your dealer ID card request.

As an alternative in the unlikely event we are unable to respond in a timely fashion, click here to see a list of Insurance Carrier customer service phone numbers. Most of the companies on the list linked above provide after hours support for ID Card issuance.

Is this ID Card in the Name of a Person or Business?*
- ID Card for a Person(s) or Individual(s)
- ID Card for a Business (Corp, LLC, etc)
Name on ID Card as it will read on the Title and Registration*
First Middle Last Suffix
2nd Name on ID Card (if applicable)
First Middle Last Suffix
Business Name (as it will read on the Title & Registration)
Address (as it will appear on the Title & Registration)*
Street Address Address Line 2 City State ZIP Code
Best Client Email
Best Client Phone Number
Date of Delivery*
Month
Day
Year
ID Cards Needed By:*

: Hours

Minutes

AM/PM
Purchased Vehicle Information*
Year Make Model VIN
Is the Purchased Vehicle New or Used?*
Is this Vehicle Receiving NEW Plates or are Plates being TRANSFERRED?*
Information of vehicle being replaced or transferred plates
Year Make Model VIN
Is this Vehicle Financed, Leased, or Neither?*
Does the Financing or Leasing Company Require a BINDER in addition to the ID Card?*
- Yes
- No
Name of Financing or Leasing Company*
Address of Financing or Leasing Company*
Street Address Address Line 2 City State ZIP Code
Dealership Name & City*
Sales or Title Person’s Name*
First Last
Best Salesperson or Dealership Voice Number*
Dealership Fax Number or email to receive ID card*
Additional Information or Instructions? We Love Feedback!
This field is for validation purposes and should be left unchanged.
This field is for validation purposes and should be left unchanged.

The next step is easy, call 607-724-0404 or 570-853-4777 Or, Contact Us

About Empire Insurance Agency

We’re an independent insurance agency offering a comprehensive suite of insurance solutions to protect you from the unexpected.

We don’t just sell insurance. We work closely with clients to help them make important and informed decisions every day when it comes to protection and their future.

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We offer comprehensive insurance solutions throughout New York, including Broome County, Greater Binghamton Area, Triple Cities, Southern Tier of NY, Binghamton, Johnson City, Endicott, Endwell, Vestal, Apalachin, Owego, Maine, Newark Valley, Chenango Bridge, Chenango Forks, Conklin and Susquehanna Valley. Also throughout Northeast PA, including Susquehanna County, Hallstead, Great Bend, Montrose and New Milford.

Dealer ID Card Request

PLEASE NOTE: We monitor this online request during business hours. Typically we are able to respond within 60 minutes if we are able to confirm coverage.

There may be occasions where we are not available during normal business hours. We ask that you always fill out this form as the first step in obtaining an ID card.

Contact Us

Submit your dealer ID card request.

As an alternative in the unlikely event we are unable to respond in a timely fashion, click here to see a list of Insurance Carrier customer service phone numbers. Most of the companies on the list linked above provide after hours support for ID Card issuance.

Call Us Today

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