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743 N 35th Street Seattle, Washington 98103

206-632-3603

Car Insurance

We're Here to Serve
All Your Car Insurance Needs

  • Coverage Questions
  • Accident Reporting
  • Help in Filing Claims
  • Towing
  • Rental Car Help

Simply Fill in the form to the right and we will get started on finding the right coverage for your vehicle and your circumstances.


 

Representing
Pemco Insurance
 farmers home
Progressive Insurance

 
Name
Address
City
State
Zip
E-mail
Phone
Fax
How did you hear about us?
Do you rent or own home?Rent Own
Do you have current auto insurance now?Yes No
Insurance Company Name
Current Insurance Renewal Date


Primary Driver

Age:

How far do you drive to work?

0-3 miles
3-15 miles
Over 15 miles
Business use
None

In the last three years
Number of Driving Citations
Number of at-fault Accidents
Number of no-fault Accidents

Car # 1
Year
Make
Model
# of Doors
Has Anti lock brakes?
Air Bags One Two None

Secondary Driver

Age:

How far do you drive to work?

0-3 miles
3-15 miles
Over 15 miles
Business use
None

In the last three years
Number of Driving Citations
Number of at-fault Accidents
Number of no-fault Accidents

Car #2
Year
Make
Model
# of Doors
Has Anti lock brakes?
Air Bags One Two None

Please select the coverage you desire

Liability Limit
Suggest

Underinsured Motorist Limit
Match above limit Reject Suggest

Medical (Personal Injury Protection)
$10,000 $25,000 $35,000 Reject Suggest

Comprehensive and Collision Deductible
100/200 500/500 1,000/1,000 Reject Suggest

Call us at (206) 632-3603 with any comments, questions or additional needs

home • auto • life
Copyright © 2006 City Insurance Center Seattle, Washington 98103