Car Insurance Minneapolis

Your Name:
Address:
City:
State:	Minnesota Only
Zip Code:
Day Time Phone:
E-mail: (REQUIRED)
E-mail again for accuracy:
Own or Rent:
How did you hear about us?

Do you have insurance now?
What auto company: (not agency)
Policy expiration date:
What is your current Liability amount?
How long have you been continuously insured?
Current annual car insurance premium:
Driver 1 - Name:
Date of Birth:
Gender:
Marital Status:
Minnesota Drivers License #:
Social Security #:
Any Tickets, Accidents or Claims in the past 5 years? Please list the occurrence(s) and approximate date:
Driver 2 - Name:
Date of Birth:
Gender:
Marital Status:
Minnesota Drivers License #:
Social Security #:
Any Tickets, Accidents or Claims in the past 5 years? Please list the occurrence(s) and approximate date:
Driver 3 - Name:
Date of Birth:
Gender:
Marital Status:
Minnesota Drivers License #:
Social Security #:
Any Tickets, Accidents or Claims in the past 5 years? Please list the occurrence(s) and approximate date:
Vehicle 1 - Year:
Make:
Model:
VIN#:
# of Doors:
Four Wheel Drive:
Anti-Lock Brakes:
Air Bag:
Anti-Theft:
Comprehensive Deductible:
Full Glass Coverage:
Collision Deductible:
Usage:
Vehicle 2 - Year:
Make:
Model:
VIN#:
# of Doors:
Four Wheel Drive:
Anti-Lock Brakes:
Air Bag:
Anti-Theft:
Comprehensive Deductible:
Full Glass Coverage:
Collision Deductible:
Usage:
Vehicle 3 - Year:
Make:
Model:
VIN#:
# of Doors:
Four Wheel Drive:
Anti-lock Brakes:
Air Bag:
Anti-Theft:
Comprehensive Deductible:
Full Glass Coverage:
Collision Deductible:
Usage:
Package Discounts:
Group Discounts:
Defensive Driver Course:
Retired Age 65+:
Is there any additional information you would like us to know?

Thank you for taking the time to complete the Minneapolis car insurance quote form. You will hear from your Insuring Minnesota consultant within 24 hours.

TERMS & CONDITIONS: Insuring Minnesota cannot bind, modify or cancel coverage via submissions to our website, or by messages sent through e-mail. Completion and submission of this form or e-mail does not constitute either a binder or an application for insurance. This site provides quotes and information only. An application signed by you and our agent is required for insurance to become effective.

Insuring Minnesota
20960 Holyoke Ave Lakeville, MN 55044
Phone: 952-469-0425 - Fax: 952-469-1881
info@insuringminnesota.com

Complete our simple on-line Minneapolis car insurance quote form.

It only takes a couple of minutes!