American Central Insurance Services3300 Hedley Road
Springfield, Illinois 62711
Phone: (217) 698-9000
Fax: (217) 698-9898

Auto ID Card Request

Requestor Information

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Policy Information

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Vehicle 1 Information

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Vehicle 2 Information

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Vehicle 3 Information

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Questions or Comments

Binding Agreement

(Required) I understand that any policy changes and quote requests are effective only when I have received a written confirmation.*

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This submission is a request. Insurance coverage changes and new coverages are not effective until we confirm that for you.

We will do our best to complete this request based on the information you provide. The more complete your information, the more accurate your quote will be.

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