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612-229-1179

1-800-473-2141

All Types of Insurance

 

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ABOUT OUR AGENCY

 
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Minnesota &

Wisconsin

All Types of Auto Car Insurance Coverage

Call for a free quote today!

612-229-1179

1-800-473-2141

For your convenience we gladly accept:

Minnesota Insurance, MN Insurance

Minnesota Insurance, MN Insurance

Online Auto Car Insurance Quote

Our simple form takes only 2-3 minutes to fill and submit!

 

YOUR PERSONAL INFORMATION

If you are submitting multiple forms, it is only necessary to fill in your personal information on the first one. Please, however, include your name on all submissions. Thank you.

 

We can insure you and your car if you have a drivers license from any state as long as you have a residence in Minnesota or Wisconsin.

 

Your Name: (required)
Street Address:
City:
State: MUST be Minnesota or Wisconsin
Zip Code:
E-Mail: (required)
E-Mail again for accuracy: (required)
Phone:
Fax (optional):
Marital Status:
Single Married
 
Homeowner?
Yes No
 
Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type N/C)

 

 

DRIVER INFORMATION #1
       
Name: Birthdate:
Sex (M/F):    
Number of Accidents last 3 years: Number of tickets last 3 years:
Number of major violations last 3 years:    
 

 

DRIVER INFORMATION #2 (if none, leave blank)
       
Name: Birthdate:
Sex:    
Number of Accidents last 3 years: Number of tickets last 3 years:
Number of violations 3 years:    
 

 

VEHICLE #1 INFORMATION
(if "Non-Owners", type "NON-OWNER" in "YEAR" Field)
       
Year of vehicle: Make & Model:
Annual Mileage: Used in business?
(Explain, if yes):
 
VEHICLE #1 COVERAGES:
 
Preferred Deductible
Comprehensive
Coverage:
NO Coverage
 
Collision
Coverage:
NO Coverage  
 

 

VEHICLE #2 INFORMATION (if none, leave blank)
       
Year of vehicle: Make & Model:
Annual Mileage: Used in business?
(Explain, if yes):
 
VEHICLE #2 COVERAGES:
 
Comprehensive Coverage: NO Coverage
 
Collision
Coverage:
NO Coverage  
 
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Auto Car Insurance

Serving the Communities of Minnesota MN:

Afton, Albert Lea, Andover, Annandale, Anoka, Anoka County, Apple Valley, Arden Hills, Austin, Bayport, Bethel, Blaine, Bloomington, Brainerd, Brooklyn Center, Brooklyn Park, Buffalo, Burnsville, Champlin, Chanhassen, Chaska, Cloquet, Columbia Heights, Coon Rapids, Corcoran, Cottage Grove, Cross Lake, Crystal, Dakota County, Dayton, Deephaven, Delano, Dellwood, Detroit Lakes, Duluth, Eagan, Eden Prairie, Edina, Elk River, Excelsior, Fairmont, Falcon Heights, Faribault, Farmington, Forest Lake, Fridley, Fergus Falls, Gem Lake, Golden Valley, Grand Rapids, Greenfield, Greenwood, Hamel, Hastings, Hennepin County, Hibbing, Highland Park, Hopkins, Independence, Inver Grove Heights, Lake Elmo, Lakeland, Lakeville, Lauderdale, Lexington, Lilydale, Lino Lakes, Little Canada, Long Lake, Loretto, Mahnomen, Mahtomedi, Mankato, Maple Grove, Maple Lake, Maple Plain, Maplewood, Mayer, Medina, Mendota Heights, Minneapolis, Minnetonka, Minnetonka Beach, Minnetrista, Monticello, Mound, Mounds View, Navarre, New Brighton, New Hope, Newport, North Mankato, North Oaks, North St. Paul, Norwood, Oakdale, Orono, Plymouth, Prior Lake, Ramsey, Ramsey County, Richfield, Robbinsdale, Rochester, Rockford, Rogers, Rosemount, Roseville, Savage, Shakopee, Shoreview, Shorewood, South St. Paul, Spring Lake Park, Spring Park, St. Anthony, St. Bonifacius, St. Cloud, St. Croix, St. James, St. Louis Park, St. Michael, St. Paul Park, Stillwater, Tonka Bay, Vadnais Heights, Victoria, Waconia, Washington County, Watertown, Wayzata, West St. Paul, White Bear Lake, Woodbury, Worthington, Wyoming, Young America, Zimmerman 

Serving the Communities of Wisconsin WI:

Allouez, Appleton, Ashwaubenon, Baraboo, Beaver Dam, Bellevue, Beloit, Brookfield, Brown Deer, Burlington, Caledonia, Cedarburg, Chippewa Falls, Cudahy, De Pere, Eau Claire, Fitchburg, Fond du Lac, Fort Atkinson, Franklin, Germantown, Glendale, Grafton, Grand Chute, Green Bay, Greendale, Greenfield, Hartford, Howard, Hudson, Janesville, Kaukauna, Kenosha, La Crosse, Little Chute, Madison, Manitowoc, Marinette, Marshfield, Menasha, Menomonee Falls, Menomonie, Mequon, Merrill, Middleton, Milwaukee, Monroe, Mount Pleasant, Muskego, Neenah, New Berlin, Oak Creek, Oconomowoc, Onalaska, Oshkosh, Pewaukee, Platteville, Pleasant Prairie, Plover, Port Washington, Racine, Richfield, River Falls, Sheboygan, Shorewood, South Milwaukee, Stevens Point, Stoughton, Suamico, Sun Prairie, Superior, Two Rivers, Watertown, Waukesha, Waunakee, Waupun, Wausau, Wauwatosa, West Allis, West Bend, Weston, Whitefish Bay, Whitewater, Wisconsin Rapids