Request Single Vehicle Proposal

Posting or sending unsolicited content including promotional links or advertisements is prohibited.

12 Times represents many insurance that ask a variety of questions to help you get a better insurance rate. Please use Additional Information to provide more information if needed. If you have current auto insurance you only need to tell us the year, make, and model of your vehicle as we may be able to retrieve the Vehicle Indentification Number(VIN). If you have never insured your vehicle or if the vehicle is a newly purchased, please provide the VIN number if possible. We always try to respond promptly the same day or on the next business day. Thank you for giving 12 Times Better Insurance Plus an opportunity to earn your business.

How did you hear about 12 Times? *

Full name including middle initial

First Name *

Middle Initial

Last Name *

Street *

City *

State *

ZIP / Postal Code *

Primary Phone Number *

Alternate Phone Number

E-Mail Address *

Do you currently have insurance? *

Yes
No
No, but ended less than 30 days ago
Company Vehicle
Listed on someone's auto insurance

If no, when did you last have insurance?

Current Insurance Provider

Time with current auto carrier

Do you rent or own your home?

Belong to AAA?

Yes
No

Date of Birth *

Marital Status *

License (State, Number)

Name and approximate date of any moving or non-moving violations the past 3 to 5 years

List and date any at-fault or non-fault accidents, or Comprehensive claims last 5 years

Driver 2: Full name including middle initial

Relationship *

Marital Status *

Date of Birth

License (State, Number)

Name and approximate date of any moving or non-moving violations the past 3 to 5 years

List and date any at-fault or non-fault accidents, or Comprehensive claims last 5 years

Driver 3: Full name including middle initial

Date of Birth *

Marital Status *

Submission Validation

Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

Insurance Websites Designed and Hosted by Insurance Website Builder

12 Times Better Insurance Plus

3108 A Street SE, Suite A, Auburn, WA 98002 | 253-249-7581 | 425-432-4999