Insurance Home Contact Pars Insurance Agency About Pars Insurance Agency Pars Insurance Agency Site Map Insurance Links
Pars Insurance Agency - The Agency You Trust (800) 779-7277

Insurance Careers
Client Services
Insurance Frequently Asked Questions and Information
Whats New at Pars Insurance
 
Lowest Priced California Insurance Coverages Available

  

Auto Policy Change Request

 Please complete the following general questionnaire. Our professional, courteous staff will contact you regarding your request, or call us at (800) 779-PARS.

Your Personal Data
Your Name:
Street Address:
City:
Zip Code:
E-Mail (REQUIRED):
Phone:
Policy Number:
 
TO ADD A DRIVER

Driver Information #1
Name: Birthdate:
Sex (M/F): # Years U.S.
 Licensed:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:
Number & Type of Accidents last 3 years: Number & Type of MINOR Cites last 3 years:
Number & Type of MAJOR Cites last 3 years: Daily commute
in ONE WAY miles:
Driver Information #2 (if none, leave blank)
Name: Birthdate:
Sex: # Years U.S.
 Licensed:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations in fields below:
Number & Type of Accidents last 3 years: Number & Type of MINOR Cites last 3 years:
Number & Type of MAJOR Cites last 3 years: Daily commute
in ONE WAY miles:
TO ADD A VEHICLE

Vehicle #1 Information
(if "Non-Owners", type "NON-OWNER" in "YEAR" Field)
Year of vehicle: Make & Model:
Annual Mileage: Used in business?
(Explain, if yes):
Vehicle #1 Coverages
Limits of
Liability:		 $10/20 BI / 10 PD $25/50 BI / 25 PD
$50/100 BI / 50 PD $100/300 BI / 50 PD
 
Comprehensive
& Collision:		 NO Coverage $250 Deductible
$500 Deductible $1000 Deductible
 
Do you want
Medical Coverage?		 Yes No   Uninsured
  Motorists Cov.?		 Yes No
Vehicle #2 Information (if none, leave blank)
Year of vehicle: Make & Model:
Annual Mileage: Used in business?
(Explain, if yes):
Vehicle #2 Coverages
Limits of
Liability:		 $10/20 BI / 10 PD $25/50 BI / 25 PD
$50/100 BI / 50 PD $10/300 BI / 50 PD
 
Comprehensive
& Collision:		 NO Coverage $250 Deductible
$500 Deductible $1000 Deductible
 
Do you want
Medical Coverage?		 Yes No   Uninsured
  Motorists Cov.?		 Yes No
OTHER REQUESTS OR ADDITIONAL REMARKS:
 (List additional drivers, autos, etc. here) 		 

      
 

Our courteous and experienced staff will be in touch with you shortly.
Call us (800) 779-7277

© Copyright 2010 PARS INSURANCE AGENCY. CA LICENSE # 0D91065
  Source © Insurance Information Institute, Inc.