Game Plan
your Rates
before they're
Fumbled Away

425-432-4999

Auto Insurance

Home Insurance

Business Insurance

Request Multi-Vehicle Proposal

Fill out this form and then click the submit button to send your request. Answer the questions to the best of your knowledge or leave blank if not applicable. Quotes and service are available by phone, email, video proposals, transparent screen share and safe, friendly walk-ins.

Let 12 Times plan your positive numbers before they get fumbled away.

Personal Information

First Name *

Last Name *

Street *

Vehicle 1 year, make, model

City *

State *

ZIP / Postal Code *

Primary Phone Number *

Alternate Phone Number

E-Mail Address *

Do you currently have coverage active right now?

If your insurance is not active, when did it cancel?

Do you know your Liability Limits are on your current or previous insurance?

Vehicle 1 year, make, model *

Vehicle 1 VIN

Vehicle 1 - Average Commute in Miles

Vehicle 1 - How many days per week do you commute?

Annual Miles Vehicle 1

#1 Month/Year purchased vehicle?

Vehicle 2 year, make, model

Vehicle 2 VIN

Vehicle 2 - Average Commute in Miles

Vehicle 2 - How many days per week do you commute?

Annual Miles Vehicle 2

#2 Month/Year purchased vehicle?

Are you towing anything? *

Name of Driver 1 *

Driver 1-DOB

#1-Moving or non-moving violations past 5 years-list approximate month/year

#1-Accidents at-fault or non-fault past 5 years-list approximate month

Name of Driver 2

Driver 2 -DOB

#2-USA Year/Month first licensed or age

#2-Moving or non-moving violations past 5 years-list approximate month

#1-USA Year/Month first licensed or age

#2-Accidents at-fault or non-fault past 5 years-list approximate month

Name of Driver 3

Driver 3-DOB

#3-USA Month/Year first licensed or age.

#3-Moving or non-moving violations past 5 years-list approximate month

#3-Accidents at-fault or non-fault past 5 years-list approximate month

Any Comprehensive claims last 5 years?(fire, theft, vandalism, nature, animal)

Do you Own or Rent your home?

Would you consider a Auto Homeowners package for the best prices?

Highest Level of Education

#3 - If Student, please list Grade Point Average

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 | 425-432-4999 | 253-249-7581