california auto insurance

Insurance Experience You Can Count On. Secure - Reliable - Affordable!
california auto insurance
 

 
"Service My Insurance"
Account Request Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data

Your Name
Street Address:
City:
State:
Zip/Postal:
E-Mail (REQUIRED):
Phone (REQUIRED):
Fax: (Optional)
 
Policy & Service Details
 
Your Policy Number:
 
 
What do You Need? Policy change
Insurance Certificate
Claim Assistance
Other
 
 
Describe Your Service Need in DETAIL:

If you need a certificate of insurance, list name and complete address of certificateholder here.

If you have a claim to report, give basic details only.

 
Please contact me for service via: Fax E-Mail
Regular Mail
Please Call Me!


Thank you for filling out this form COMPLETELY!

We deem your data submitted as PRIVATE information. Every step has been taken to insure your privacy, security, and to release this information only to you. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release them from any liability should this information be accidentally viewed by others. Also, the insurance carriers reserve the right to issue coverage or not, and we cannot guarantee acceptance of a risk until approved by the company.

Yes, Please Service My Account. I Understand that NO COVERAGE IS BOUND on insurance changes until confirmed IN WRITING by Alive Insurance Services, Inc..

Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!


 
You may contact our agency at the address and phone numbers below:
 
Alive Insurance Services, Inc.
6328 Fairmount Avenue, Suite 230   El Cerrito, CA 94530
Phone: Toll Free: 1-866-343-2437 / Phone: 1-510-524-3200
Facsimile: 1-510-524-0059 / Calif. Ins. License# 0E70937
E-Mail us at: ALIVE INSURANCE@aol.com