Minnesota auto, medicare plans and homeowners insurance from MN Auto Quote.com
Minnesota car insurance from MN Auto Quote.com
MN auto insurance, home insurance, medicare insurance, Free Quotes from MN Auto Quote.com
MN insurance quotes
MN insurance quotes from MN Auto Quote.com
 
Return to Home Page

 Our Clients Say it Best!

 
Visit Our Agency's Other On-Line Quote Forms and Start Saving!
 
Auto Insurance

Homeowners Ins.

Farm Insurance

Renters Insurance

Medicare Health Plans

Life Insurance

Health Insurance

Boat Insurance

Motorcycle & ATV Insurance

Business Owners

Commercial Auto Insurance



Service Your Account
About Our Agency
Privacy Notice
Contact Us
 
E-Mail:
quotes@mnautoquote.com

Toll Free Phone:
1-800-732-5752

Local Phone:
218-738-3442

Fax:
218-738-3452

Mailing Address:
Klein Insurance Agency
PO Box 307
Eagle Bend, MN 27615

MN INSURANCE GRAPHIC  
 
Free Ranch & Farm
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data:
 
Your Name:
Property Address:
City:
State: (Must be Minnesota)
Zip/Postal:
E-Mail (REQUIRED):
E-Mail
(again for accuracy):
Phone:
Fax (optional):
 
 
Dwelling Information
 
Year Dwelling Built:
Home Square footage:
 
Number of units: 1 family Duplex
Triplex Four Units
 
Occupancy: Owner Tenant
 
Type foundation: Slab Crawlspace over slab
Pier & Post Other (list in remarks)
 
Type Roof: Shingle Wood Shake
Tar/Gravel Spanish Tile
Metal Other
 
Number of stories: One 1.5
Two Three
 
Do you own animals or pets? Yes No
If yes, list type/for dogs, list breed:
 
Are You Near Brush Area? Yes No
 
# of feet to nearest
fire hydrant:
# of miles to nearest
fire station:
 
Currently Insured? Yes No
Name of Carrier & how long insured?
 
Prior Claims? Yes No
Describe claims in detail:
 
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)
 
Circuit Breakers or fuses? Breakers Fuses

# Bedrooms: # Bathrooms:
 
# Fireplaces: # Chimneys:
 
Special features
(i.e., deck, air conditioning, alarm systems, pool, etc.)
 
Coverages:
 
Dwelling Cov. $ Contents $
Liability Cov. $ Deductible $
($250, $500, $1,000, etc.)
 
Comments/Remarks
(describe any scheduled jewelry, in-home business, or other special coverages needed here):
 
 
Farmowner Underwriting Information:
 
How Many Acres? What Variety(s) of Trees?
 
Yearly Income from Operations $ Number of Workers on Site:
 
Describe Growing Operations
(describe in detail your experience, type of operations, and coverage needed):
 
Send my quotation via: E-Mail Fax
Regular Mail
Call Me by Phone

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send
Me a Farm Insurance Quote NOW!


Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!

MN insurance quote from MN Auto Quote.com
Web Site Design © 2010, Insurance Web Sales