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Fax Quote Sheet List
Applications
 Personal Lines | Commercial P & C/Professional | Garage Liability  |Transportation | Misc. Agency Forms
 
All of our applications can be viewed with Adobe Acrobat Reader.  Some of our applications can be completed from your desktop, these applications are indicated with "Fill In" after the application.   Click "Need Help" if you are not sure which application you need and you will be direction to that product's main page which will break down products and their applications

 

 

Personal Lines Need Help?
Mobile Home| Motor Home| Dwelling |Watercraft/ Marine | Motorcycle | Collector Car |  Umbrella |Top
 
Mobile Home
bullet Mobile Home Fax Quote Sheet - Fill In
bullet American Modern Mobile Home  6/03 - AK  - fill in online
bullet American Modern Mobile Home 9/05 - WA
bullet American Modern Mobile Home 3/06 - OR
bullet Markel Mobile Home 1/06 - WA/OR
bullet Heating Source Questionnaire
bullet Personal Effects Inventory
bullet American Modern EZ Pay Authorization Form
 
Motor Home  
bullet Motor Home Fax Quote Sheet - Fill In
bullet American Modern Motor Home - AK
bullet American Modern Motor Home - WA 7/04
bullet  American Modern Motor Home - OR 6/04ed
bullet Markel Motor Home - AK
bullet Markel Motor Home - OR 
bullet Markel Motor Home - WA
bullet American Modern Travel Trailer - OR 6/04 ed
bullet American Modern Travel Trailer - WA 7/04
bullet American Modern Travel Trailer - AK 7/04
bullet Markel Supplemental Motor Home - AK/OR/WA
bullet American Modern EZ Pay Authorization Form
  
   
Dwelling  
bullet Dwelling Fax Quote Sheet - Fill In
bullet American Modern Dwelling - WA02/06
bullet American Modern Dwelling - OR 02/06
bullet American Modern Dwelling - AK
bullet American Modern Home Owner - 2/06
bullet Lexington Home Owners and Rentals Application - AK/WA/OR
bullet Lexington Home Owners and Rentals Supplemental - AK/WA/OR
bullet Lexington Corporate Named Insured Questionnaire
bullet Lloyd's Home Owners - WA
bullet Sutter Home Owners HO3 - WA/OR-  Submit Acord Applications with Photos
bullet Sutter Home Owners HO8 - WA? OR - Submit Acord Applications with Photos
bullet Sutter Older Home Supplement
bullet Markel Dwelling - AK 03/05 Edition
bullet Markel Dwelling - WA 04/06 Edition
bullet Heating Source Questionnaire
bullet American Modern EZ Pay Authorization Form
  
   
Watercraft/ Marine  
bullet Watercraft/ JetSki Fax Quote Sheet - Fill In and Submit Online
bullet American Modern Personal Watercraft
bullet American Modern First Choice Watercraft 0608
bullet American Modern EZ Pay Authorization Form
bullet Markel Watercraft Quote Sheet
bullet Markel Yacht Application
bullet Markel High Performance Application
  
 
Motorcycle
bullet Motorcycle Fax Quote Sheet - Fill In
bullet American Modern Motorcycle - OR
bullet American Modern Driver Exclusion - OR
bullet American Modern Motorcycle 04/04 - WA
bullet American Modern Driver Exclusion - WA
bullet American Modern Motorcycle UIM Rejection form - WA
bullet American Modern EZ Pay Authorization Form
 
Elite Collector Car
bullet Collector Car Fax Quote Sheet - Fill In
bullet Elite Washington Application 4/06
bullet Elite Oregon Application 4/06
bullet Elite Program Guidelines Updated 8/07
bullet Driver Health Report
bullet Alternate Garaging Location Supplement
bullet American Modern EZ Pay Authorization Form
 
Personal Umbrella - WA, OR & AK
bullet Scottsdale Umbrella Application
bullet Scottsdale Umbrella Renewal Application
bullet Scottsdale Medical Statement
 
Commercial P & C/ Professional  Need Help?
 Contractors | Property | Inland Marine | General Liability | Professional |BOPs | Top
 
Contractors - Include loss runs with application
bulletClick for programs and applications
bullet Contractor's Application Fill In & Submit Online!
bullet Welder's Supplement
 
Property
bullet Vacant Building - Fill In
bullet Residential Property(S2647IL 7/04)
 
Inland Marine
bullet Builder's Risk - Fill In
bullet Contractor's Equipment
bullet Hole In One
 
General Liability
bullet Amusement Center (S1211CG)
bulletContractors (Bookmark to contractor's section)
bullet Day Spa Supplemental Application
bullet Homeowners/ Condo Association Supplemental Application
bullet Guides and Outfitters (S368 5/91)    Fill in Online
bullet Mobile Home Park (S2587-CG)          Fill in Online
bullet Pawn Shop Supplemental Application
bullet Restaurant /Tavern /Bar  Supplemental Application AK
bullet Restaurant /Tavern /Bar  Supplemental Application WA/OR
bullet Liquor Liability Application WA/OR
bullet Special Events(S62CG)                     Fill in online
bullet Sporting Camps/ Leagues Supplement Application(S1261CG)
bullet Swimming Pool Application
bullet Truckers GL - S2627-CG (1/05)
 
Professional Liability
bullet Beauty Salon / Barber Shop(S452PL)
bullet Day Care(S20PL)                                        Fill in Online
bullet Exercise Health Club(S307PL)                Fill in online
bullet Exercise Health Club Supplemental Application
bullet Health Care Provider(S352PL)
bullet Shelter/Workshops/Rehabilitation Facilities(S309PL)
bullet Tanning Salon Supplemental Application(S1248PL)
 
BOPs
bullet3-B / Beauty, Barber, Body Application
bullet Brochure
bullet Child Care Application
bullet Brochure
 
Garage Liability  Need Help?
Auto Dealer | Non-Dealer|  Top

 
Auto Dealer  - Non Franchised
bulletFirst Financial/Burlington Dealer Application - WA/OR
bulletFirst Financial UM/UIM - OR
bulletFirst Financial UM/UIM  - PIP - WA
bullet National Indemnity Used Motor Home Dealer Application 02/07 - AK
bullet National Indemnity Used Motor Home Dealer Application 02/07 - OR
bullet National Indemnity Used Motor Home Dealer Application 02/07 - WA
bullet National Indemnity Trailer Dealer Application 02/07 - WA
bullet National Indemnity Trailer Dealer Application 02/07 -OR
bullet National Indemnity Trailer Dealer Application 02/07 -ak
bullet National Indemnity Motorcycle/RV Dealer Application02/07- WA/AK/OR
bulletNational Indemnity AK Rented Vehicle - AK
bulletNational Indemnity AK Driver Questionnaire - AK
bullet National Indemnity UM Form - AK
bullet National Indemnity UM Form - OR
bullet National Indemnity UM Form - WA
 
Non - Dealer
bullet National Indemnity Auto Service Application 02-07 AK
bullet National Indemnity Auto service Application 02-07 WA
bullet National Indemnity Auto service Application 02-07 OR
bulletAuto Service Supplement
 
Transportation Need Help?
Truck |  Business| Public | SpecialNational Indemnity Auto Service Application 8/06 WA |Other |Top
 
Truck
bullet Lincoln General Truck Application 09/05 - ID/OR/WA
bullet National Indemnity Truck Application 11/03  - AK
bullet National Indemnity Truck Application 11/03 - ID
bullet National Indemnity Truck Application 11/03 - OR
bullet National Indemnity Truck Application 8/06 - WA
bullet Northland Truck Application - WA 01/07
bullet Northland Truck Application - OR 9/05
bullet Northland Truck Supplement Application - OR/WA
bullet Northland Fleet 10+ units- WA 03/07
bullet Northland Fleet 10+ units- OR 04/07
bullet Northland Striping Request
bulletSee "Others" below for more useful forms
 
Business
bullet National Indemnity Business Auto Application 11/03 - AK
bullet National Indemnity Business Auto Application 11/03 - ID
bullet National Indemnity Business Auto Application 11/03 - OR
bullet National Indemnity Business Auto Application 8/06 - WA
bullet Northland Business Auto Application - 3/07 OR
bullet Northland Business Auto Application - 3/07 WA
bullet Northland Business Auto Hired supplement -
bullet Northland Business Auto non-owned supplement-
bulletSee "Others" below for more useful forms
 
Public
bullet National Indemnity Public Auto Application 11/03 - AK
bullet National Indemnity Public Auto Application 11/03 - ID
bullet National Indemnity Public Auto Application 11/03 - OR
bullet National Indemnity Public Auto Application 8/06 - WA
bullet Northland Public Auto Application 3/07- OR
bullet Northland Public Auto Application 03/07 - WA
bullet Northland Public Auto Hired Supplement
bullet Northland Public Auto non-owned supplement
bullet Northland Public Auto Supplement - OR/WA
bulletSee "Others" below for more useful forms
 
Special
bullet National Indemnity Special Types Application 11/03 - AK
bullet National Indemnity Special Types Application 11/03 - OR
bullet National Indemnity Special Types Application 8/06- WA
bulletSee "Others" below for more useful forms
 
Other
bullet Lincoln General Cargo Supplement 09/05
bullet Lincoln General Flatbed Supplement 03/06
bullet Lincoln General General Liability Supplement 07/06
bullet Lincoln General Intermodal Questionnaire 09/05
bullet Lincoln General Logging Supplement 09/05
bullet National Indemnity Cargo Only App
bullet National Indemnity UM Form - AK
bullet National Indemnity UM Form - ID
bullet National Indemnity UM Form - OR
bullet National Indemnity UM Form - WA
bullet National Indemnity Driver Questionnaire - AK
bullet National Indemnity Driver Questionnaire - ID/OR/WA
bullet National Indemnity AK Rented Vehicle Form - AK
bullet National Indemnity Cargo Supplement 12/06 - AK/ID/OR/WA
bullet National Indemnity Hired & Non-Owned Supp. 11/03 -WA
bullet National Indemnity Auto Inspection Report - AK/ID/OR/WA
bullet National Indemnity Limo Supplement - AK/ID/OR/WA
bullet National Indemnity Renewal Application 08/06 - AK/ID/OR/WA
bullet National Indemnity Short Term Rental Application-WA
bullet National Indemnity Short Term Rental Application-OR
bullet National Indemnity Short Term Rental Application-AK
bullet National Indemnity Short Term Rental Application-ID
bulletNational Indemnity Tow Truck Supplement 08/06 - WA
bulletNational Indemnity Tow Truck Supplement 08/06 - AK/ID/OR
bullet National Indemnity Excess Auto Supplement 8/06 - AK/ID/OR/WA
bullet Northland PIP Form - WA
bullet Northland UM Form - WA
bullet Northland UM Form - OR
bullet Northland Vehicle Inspection
bullet Northland Driver Employment History Form
bullet Northland GL Supplement - WA 03/06
bullet Northland GL Supplement - OR 03/06
bullet Northland Filing Supplement
bulletNorthland credit score authorization
 
Misc. Agency Forms      Top
bulletAcord No Loss Letter
bulletAK Due Diligence
bulletOR Due Diligence
bulletAgency Set-up Request (to apply to write with PIU)

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Personal Lines | Commercial P & C/Professional | Garage Liability | Transportation

PO Box 2007 • 627 Dayton St • Edmonds WA 98020 - 9507

 Phone 800-562-8403 / 425-771-8988 • Fax 888-814-8701 / 425-775-9046 • Email info@piuinc.com