Advanced Insurance Solutions Woodinville, King County, Washington State

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Toll Free: 877-236-5868
King County: 425-485-7477

Auto Loss Notice

Automobile Loss Notice

Contact Information

Your Full Name: (as listed on policy now)
Your Email Address:
Daytime Telephone Number:

Description of Loss

Time & Date of Accident/Claim:	Time AM PM Date
Location of Accident:
Description of Accident:
Police Notified?:	Yes No
Were you ticketed?:	Yes No
If you received a ticket, what was it for?:
Driver Name:

Any Additional Information Not Requested Above


Please Note: Submitting this form via the website does not constitute a "formal" claim. Please contact us or your insurance company to notify of a loss.

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homeowners, long term care, manufactured homes, miscellaneous commercial, motorcycle, motorhome,
permanent life, property and liability, renters, special liability, term life, umbrella insurance
serving all of Washington State from our offices in Woodinville.

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