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Mailing Address Only: 4227 S Meridian Ave #D327
Puyallup, WA 98373
Phone: (253) 527-6261
Email: clientcare@pnwinsurancegroup.com

Insurance
- Personal Insurance
- Commercial Insurance
Service
FAQs
About
Contact

Request A Quote

Home Quote Request

Home Intake Form

Name(Required)

First Last

Gender

Date Of Birth(Required)

Month

Day

Year

Cell Phone

Email(Required)

Occupation and Employer Name

Marital Status

Single

Married

Spouse/Partner Name

First Last

Address of Property to be quoted

Street Address City State ZIP Code

Will this be mailing address?

Date of Birth

Month

Day

Year

Cell Phone

Do you opt in for texting?

Yes

No

We will use text to communicate about insurance issues with us.

Occupation/Employer

Mailing Address

Street Address City State ZIP Code

Is this a new purchase?

Yes

No

Prior Address

Street Address City State ZIP Code

Requested Agent:

Property Purchase Date

MM slash DD slash YYYY

Date Insurance will be needed / is needed?

MM slash DD slash YYYY

Is your insurance paid by a mortgage on an escrow account?

Yes

No

Is this your primary residence?

Yes

No

If no, is this a secondary home or rental property (tenant occupied)

Is the property held in your Trust?

Yes

No

If yes, please provide Trust Name and Date Established

Is the property under construction, vacant, unoccupied or for sale?

Yes

No

If yes, please explain

Are there pets or livestock at the property?

Yes

No

If yes, provide detail

Please indicate all animals and primary breed for any dogs.

If you have dogs. is there any bite history?

Yes

No

Is any business conducted or are you self-employed operating on the premises?

Yes

No

If yes, please explain

Any skateboard ramps, bicycle jumps, or trampolines on the premises?

Yes

No

If yes, please explain

Any swimming pools, jacuzzis, hot tubs or spas on the premises?

Yes

No

Does the insured engage in any type of residential farming?

Yes

No

If yes, please explain

Do you own any luxury, high value items, collections or collectibles with a purchase price over $1,000 each or $5,000 collectively?

Yes

No

If yes, please explain

Any detached structures? (Guest House, Pool House, Outdoor Kitchen, etc.)

Yes

No

If yes, please explain

*Utility Updates: If you don't know, please put unknown and follow up with Realtor, Current Owner, or Property Manager for information.

If your home is older than 15 years has the roof been replaced?

Yes

No

If your home is over 25 years old have any of these systems been updated?

Yes

No

Year Roofing Replaced

Year Plumbing Updated

Year Electrical Updated

Year HVAC Updated

How did you hear about us?

UPLOAD CURRENT POLICY DECLARATION PAGES HERE*

Max. file size: 98 MB.

*If the information provided through this Form are incomplete or incorrect, your final quote may change.

Would You Like Us To Review Your Policies?

What would you like a quote for? Check all that apply:*
- Home
- Auto
- Motorcycle
- Renters
- Business
- Classic Car
- Boat & Jet Ski
- Earthquake
- Life Insurance
- Umbrella
- Rental Property
- Other
PNW Insurance is Licensed in Washington State, Oregon, Idaho, Arizona and New Mexico - Is the property you wish to insure in one of these states? If not, regrettably we will not be able to help. Please visit Trustedchoice.com for more options
- Yes
- No
- Moving to a PNW licensed state
Primary Policyholder Name*
First Last
Business Name (If Applicable)
Your Phone Number*
Your Email*
What is your preferred method of contact?*
- Text
- Email
- Phone Call
How did you find our agency?*
- Google
- Facebook
- Instagram
- Pinterest
- YouTube
- Customer Referral
Who referred you to us?*
Current Insurance Provider*
Date Quote Needed*
MM slash DD slash YYYY
If you have any other questions, comments or requests, please leave them here
SMS Text Communication Consent
I agree
By submitting this form, you consent to receive SMS messages and/or emails from our company. To unsubscribe, follow the instructions provided in our communications. Msg & data rates may apply for SMS. Your information is secure and will not be sold to third parties. See Privacy Policy for details.
SMS Text Communication Consent*
By submitting this form, you consent to receive SMS messages and/or emails from our company. To unsubscribe, follow the instructions provided in our communications. Msg & data rates may apply for SMS. Your information is secure and will not be sold to third parties. See Privacy Policy for details.
- I agree
- I do not agree

About PNW Insurance Group

PNW Insurance Group is a local and independent insurance agency based in Puyallup, Washington serving Washington state and the greater Pacific Northwest. We are relationship driven insurance agents focused on making the insurance buying process as easy as possible. Whether you need home insurance, auto insurance, or any other insurance, we can help. Contact us today!

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Puyallup Office

MAILING ADDRESS ONLY:
PNW Insurance Group
4227 S. Meridian Ste D #327
Puyallup, WA 98373

PHYSICAL ADDRESS:
1115 W Pioneer (inside Bay Equity)
Puyallup, WA 98373

(253) 527-6261

clientcare@pnwinsurancegroup.com

Ferndale Office

(360) 488-2754

bj@pnwinsurancegroup.com

Monroe Office

(425) 375-7200

jake@pnwinsurancegroup.com

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