Need Something Done on Your Policy?

Certificate before a load. Adding a truck or a driver. A change to your coverage, or just a question you need answered today. Fill out the form below and tell us what you need. It goes straight to the team that handles your account, the same people who know your operation. We'll get on it and get back to you. The more detail you give us up front, the faster we move.

Need it handled right now? Call the office at (509) 795-1300.

1How can we help?

2Your information

3Certificate of insurance

4ID cards

5Policy change

6Make a payment

7Report a claim

8Existing claim

9General question

10Review and submit

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This field is for validation purposes and should be left unchanged.

Tell us what you need and we will route it to the right person.

What can we help you with?(Required)

Certificate of insurance

ID cards

Policy change

Make a payment

Report a new claim

Question about an existing claim

General question or something else

Legal business name(Required)

Owner or insured full name(Required)

First Last

Policy number(s)

If you have them handy. Leave blank if not, we can look it up.

Phone number(Required)

Email address(Required)

We will send your confirmation here.

You are always copied on certificate requests.

Certificate holder name(Required)

Certificate holder email(Required)

Enter Email Confirm Email

Certificate holder address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

When do you need it by?

Additional requests

Add certificate holder as additional insured

Add certificate holder as loss payee

Include vehicle schedule

Include driver schedule

Other specific request

Please describe the request(Required)

Which vehicles need ID cards?(Required)

Year

Make

Model

VIN

Add a row for each vehicle.

What would you like to change?(Required)

Add or remove a driver

Add or remove a truck or trailer

Update contact information

Update payment method

Cancel the policy

Something else

Driver changes(Required)

Add or remove

First name

Last name

Date of birth

Driver license state

Driver license number

CDL years of experience

CDL class

Add a row for each driver. Mark each row as Add or Remove.

Vehicle changes(Required)

Add or remove

Year

Make

Model

VIN

Value

Owned, leased, or rented

Lienholder or loss payee

Add a row for each unit. To remove a vehicle, send a copy of the bill of sale or lease termination. Insurance companies require this if your policy has federal filings.

What contact information should we update?(Required)

Phone number

Email address

Addresses

Business name or entity change

Updated phone number(Required)

Updated email address(Required)

Enter Email Confirm Email

Which addresses should we update?(Required)

Business mailing

Business physical

Equipment garaging

Updated business mailing address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Updated business physical address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Updated equipment garaging address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

New business name(Required)

Updating your payment method
For your security we do not collect card or bank details through this form. After you submit, we will email you a secure link to update your payment method on file.

Before you cancel
If you have federal insurance filings, cancellation requires a minimum of 35 days, unless you provide a declarations page for the replacement policy or proof of authority revocation. We will email you a cancellation form (LPR) for e-signature using the effective date below.

Upload your replacement policy declarations page

Drop files here or

Accepted file types: pdf, jpg, jpeg, png, Max. file size: 25 MB, Max. files: 5.

Describe the change you need(Required)

Requested effective date(Required)

This is a request. Your producer will confirm the actual effective date.

Pay the agency

Make a payment to Pullsure

Paying a carrier or finance company directly

Progressive
Great West Casualty
Berkshire Hathaway
IPFS

These links open in a new tab. Your form entries are saved.

Anything we should know about this payment?

Optional. Tell us the amount or which policy so we can match it to your account.

Report the claim directly to your carrier as soon as possible, ideally within 24 hours.
Use this form to document the loss for your records and ours. It does not replace reporting to the carrier.

Date of loss(Required)

Time of loss(Required)

Hours

Minutes

AM/PM

Which of your vehicles was involved?(Required)

Location of loss(Required)

As exact as possible. Include mile marker, intersection, or cross street.

Point of impact(Required)

Describe the damage to your vehicle first, then the other party's. Example: IV collided with CV in intersection, POI: IV front driver fender to CV front of vehicle.

Was a police or fire report filed?(Required)

Yes

Which report, and what is the report number?(Required)

Were any violations or tickets issued?(Required)

Yes

Who received them, and for what?(Required)

Is your vehicle still drivable?(Required)

Yes

Not drivable if legal lights are damaged, such as headlights at night or brake lights.

Where is the vehicle now?(Required)

Side of road, tow yard, shop, and so on.

Describe the loss in as much detail as possible(Required)

Photos of the scene or damage

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, mp4, mov, Max. file size: 25 MB, Max. files: 20.

Claim number

If you have it.

Date of loss

What is your question?(Required)

How can we help?(Required)

Anything else we should know?

Optional. Add any detail that does not fit above.

Please agree to the statement(Required)

I understand that this submission is a request, not a confirmation of processed changes. No requests have been processed until a licensed producer completes the request.

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(509) 795-1300

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