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Insurance Service, Claim Report,
or Certificate of Insurance
Onine Request Form
One Simple Form - takes only 2-3 Minutes!

Your Personal Data

Your Name
Street Address:
Fax: (Optional)
Policy & Service Details
Your Policy Number:
What do You Need? Policy change
Insurance Certificate
Claim Assistance
If Change of Bank, List Bank Loan #, and Full Insurance Mailing address here (and any remarks):

If Change of Truck or Vehicle, List Full Year, Make, Model, Purchase Price, and Vehicle ID# Here (also let us know if additional car, or replacement & which car to remove):

If You Are Reporting a Claim, Give us AS MANY DETAILS as you Can (including witnesses, police report #, and anything else you may have.):

If You Are Requesting a Certificate of Insurance, give us name and address (and fax#) of party requesting it.

If You Are Requesting a Certificate of Insurance, Please give us job details and other info we may need.

Describe Any Other Service Need You Have, in DETAIL:
Please contact me for service via: Fax E-Mail
Regular Mail
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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 OUR AGENCY.

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Our Clients Tell Our Story Best!
PA truck and business auto insurance quotations
"I have been coming to The Imperial Agency for years for all of my contractor needs and they have been great. I always get the best service and pricing!"
Joe Depaino

"I starting going to The Imperial Agency about 2 years ago to help with registering my heavy trucks and trailers. Kim helps me through the entire process and is always fair with the prices. I will continue to use them for many years to come."
Andriy Lytvynov

"I recently used The Imperial Agency to help with registering my tractor trailer. They did such a great job I also used them to help with my DOT authorities and now help with my insurance. I always trust their knowledge and I am very satisfied with the timely service I receive."
Roman Kushpinskyy

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The Imperial Agency, Inc. | 193 W. City Avenue | Bala Cynwyd, PA 19004

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Pennysylvania Truck is a team of highly dedicated professionals who specialize in PA Truck Insurance. We prepare fast, individualized truck insurance quotes, and can be found in major search engines under the following helpful truck, business auto, and commercial vehicle insurance search terms: Pennsylvania truck insurance, PA truck insurance, Pennsylvania trucking insurance, PA commercial vehicle insurance, PA commercial truck insurance, PA truck and van insurance, Pennsylvania truck and business auto insurance, low cost PA dump truck sand and gravel truck insurance, discount box truck insurance, PA cargo and delivery van insurance, low truck insurance rates, low cost PA truckers insurance, PA long haul and semi-truck insurance, fast quotes on Pennsylvania commercial truck insurance.