www.allaninsuranceagency.com/autoquote
Auto Quote

Date:

Last Name:

First Name:

Primary Phone Number:

Email Address:

Address, City, State, Zip:

If you currently have insurance who is your current provider?

Expiration Date of Policy

Drivers: Name, DOB, Marital Status, GPA(student), License #

Vehicle: Make/ Model, Year, Vin #, and Coverage wanted

Tickets or Accidents: Last 3 years

Vehicles: Loan (comany name, address)

Custome Equipment

Access to any other vehicles: ex. company car

Email Address

Please fill out the following questions if you would like an agent to quote your auto insurance. Once an agent has quoted your auto insurance, an agent will either give you a call or send you an email as soon as possible.

312 S. 1st Street

Selah, WA 98942

 

Phone #: 1-509-697-5383

Fax #: 1-509-697-5365

 

 

Tammy Allan (Agent)

ALLANINSURANCE@FAIRPOINT.NET

 

Ken Allan (Agent)

KENALLAN@FAIRPOINT.NET

 

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