Used Cars in Pennsylvania - AmericanParkway.com - Allentown, PA Pre-owned Imports and Domestic Vehicles American Parkway Auto Sales Near Philadelphia

APPLY FOR INSURANCE!

American Parkway Auto Sales Has The Automotive Insurance Solution that you Need

Submit your information below

* required

Applicant Information
* Name:
* Address:
* Phone Number:
Work Number:
* Email:

Previous Insurance History
Can you provide 6 months of continuous insurance coverage without a lapse?	Yes No
What company?
Policy number if available:

Drivers in Household
Applicant
Drivers License Number:
Driver License State:
Date of Birth:
Social Security Number:
Marital Status:
At Fault Accidents Within 5 Years:
Traffic Violations Within 5 Years:

Second Driver
Name:
Drivers License Number:
Driver License State:
Date of Birth:
Social Security Number:
Marital Status:
At Fault Accidents Within 5 Years:
Traffic Violations Within 5 Years:

Third Driver
Name:
Drivers License Number:
Driver License State:
Date of Birth:
Social Security Number:
Marital Status:
At Fault Accidents Within 5 Years:
Traffic Violations Within 5 Years:

Fourth Driver
Name:
Drivers License Number:
Driver License State:
Date of Birth:
Social Security Number:
Marital Status:
At Fault Accidents Within 5 Years:
Traffic Violations Within 5 Years:

Vehicles
Vehicle 1
* Year:
* Make:
* Model:
VIN #:
Anti Theft System:	Yes No

Vehicle 2
Year:
Make:
Model:
VIN #:
Anti Theft System:	Yes No

Vehicle 3
Year:
Make:
Model:
VIN #:
Anti Theft System:	Yes No

Vehicle 4
Year:
Make:
Model:
VIN #:
Anti Theft System:	Yes No

In order to determine your eligibility, we are required to verify the driving history, loss history and hold on insurance financial score for all drivers, using consumer reports. By clicking "I AGREE" below, you will give American Parkway Auto Sales permission to use any information obtained in this form to quote, issue or renew your insurance. You have the right to access and correct all personal information collected. I AGREE

	American Parkway Auto Sales 301 W Union Street Allentown, PA 18102 (610) 435-0750 Fax: (610) 435-5960
Check Back as our Inventory is Updated on a Weekly Basis