541.536.1718 -or- 800.506.1718

La Pine Insurance Center – Request A Policy Change

We accept all policy changes by phone during business hours.

We recommend you contact our office if you have any questions about your coverage.

You may submit your policy change request to us by email. Changes are not in effect until notified by the agency or carrier. This in no way asserts or maintains that there is coverage available on your policy, that the change is acceptable by the insurer, or places a binder on any such coverage. If you submit a request and are not contacted within 1 business day please follow up by contacting our agency.


Current Insurance Information


Please Fill Out The Appropriate Form Below


Automobile Information


Deductibles & Miscellaneous


Driver Information


Driver's License Information


Driver History

Please list ANY convicitons for ANY moving traffic violation in the past 3 years.


Please list ANY license suspensions, revocations, or driving under the influence convictions.


Please list ANY accidents, regardless of fault, in the past 5 years.


Change Of Lien-holder

I understand that by clicking the policy change request button below that changes are not in effect until notified by the agency or carrier. This in no way asserts or maintains that there is coverage available on your policy, that the change is acceptable by the insurer, or places a binder on any such coverage.

If you have not heard from our office in 24 hours during the week, or the next business day in the case of a weekend, please contact us by phone.

La Pine Insurance Center

Phone: 541-536-1718 | Toll Free: 800-506-1718 | Fax: 541-536-5032