Heating Oil Pollution Liability Insurance Registration Form

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!