Auto Insurance Quote

Auto Insurance Quote
(Washington & Idaho residents only)

Please fill out our fast-form quote below to help in obtaining the appropriate quote for you. There are no required fields, and any information you give will be confidential (we do not provide information to third parties—see our privacy policy).

If you prefer not to complete this form, please email your request to timo@cio.net, or you may obtain a quote by faxing your information and current auto insurance declarations pages to 509-921-6955. As well, you can talk to one of our agents in person by calling 509-921-6809 or toll free at 800-356-4231.

NOTE: Some companies use credit as a means for quoting, which is called insurance scoring. Though not required, you may benefit from allowing us to obtain an insurance score for you, no matter what your current credit standing is.

Auto Insurance Fast-Form Quote

Name

Address

City

State

Zip

E-mail (enter correctly or leave blank)

Phone

Social Security Number

May we obtain an insurance score?

YesNo

Present auto insurance company

Not Presently Insured

How long?

Date auto
insurance expires

Current
monthly payment

Length at present address

Time in current profession

Do you own a home?

Yes No

Vehicle #	Vehicle Identification Number (VIN) if known	Year	Make (i.e., Ford)	Model & Class (i.e., Windstar GL)
1
2
3
4

Vehicle #	Business/Pleasure	2dr/4dr	Miles to Work (one way)	Annual Mileage
1
2
3
4

	Driver 1	Driver 2	Driver 3
Driver Name
Date of Birth
Sex
Drivers License Number
Marital Status
Occupation
Number of Violations Last 3 Years
Number of Accidents Last 3 Years	At fault?YesNo	At fault?YesNo	At fault?YesNo

	Driver 1	Driver 2	Driver 3
Percent of Use Vehicle #1
Percent of Use Vehicle #2
Percent of Use Vehicle #3

Vehicle #	Automatic Seat Belts	Anti-Lock Brakes	Air Bags	Alarm	Leased Vehicle
1	Yes No	2-wheel 4-wheel	One Two	Active Passive	Yes No
2	Yes No	2-wheel 4-wheel	One Two	Active Passive	Yes No
3	Yes No	2-wheel 4-wheel	One Two	Active Passive	Yes No

LIABILITY LIMIT FOR ALL VEHICLES*

Split Limits

Bodily Injury

Property Damage

Combined Single Limit (choose one)

$25,000/$50,000

$10,000

$60,000

$50,000/$100,000

$25,000

$100,000

$100,000/$300,000

$50,000

$300,000

$250,000/$500,000

$100,000

$500,000

$500,000/$1,000,000

$500,000

$1.000,000

*Choose either Split Limits OR Combined Single Limit

Quote with Uninsured/Underinsured Motorists (UIM)

Quote with Personal Injury Protection (PIP)

Check here for state minimum limits only

Vehicle #	Deductible Comprehensive (theft, windshields, animals, etc.)			Deductible Collision
1	$100	$250	$500	$250	$500	$1000
2	$100	$250	$500	$250	$500	$1000
3	$100	$250	$500	$250	$500	$1000

Vehicle #	Towing	Loss of Use (Rental Reimbursement)
1	YesNo	YesNo
2	YesNo	YesNo
3	YesNo	YesNo
Please include comments (info on tickets, at-fault accidents, coverage requests, or auto safety features).

Please note this is for a quote only and does not bind coverage in any way.

Some of your available options:

• Transfer Discounts	• Mature Driver Discounts	• Business Use	• SR-22 Filing
• Safety Discounts	• Multi-Car Discounts	• Young Driver	• Broad Form
• Homeowner Discounts	• Alarm Discounts	• No Prior	• 1 Month Down
• Safe Driver Discounts	• Poor or No Credit	• Bad Driving Record	• Monthly Payments

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