Please review the form instructions and additional information about this program. You may also print the form (pdf), fill out, and mail or fax completed registration form to:
Pollution Liability Insurance Agency
PO Box 40930
Olympia WA 98504-0930
Fax: (360) 407-0509
Please note that your information is saved on our server as you enter it. If you need to finish the form at a later time, please scroll to the bottom of the form and click the “Save and Continue Later” link. NOTE: You must enter an email address in this form in order to save and continue your entry. Thank you!