1st State Agency of Sauk Centre, Minnesota, will contact you by phone within 3 business days.
Be prepared with your vin number.

*Last
*First
*Middle
*Address
*City
*State
*Zip
*Home Phone
Work Phone
Fax
Email

Mailing Address if different from above
Street
City
State
Zip

Driver 1
First Name
Last Name
Gender
Male
Female
Marital Status
State Licensed
Driver's License Number
Occupation
Date of Birth
Good Student
 
Driver 2
First Name
Last Name
Gender
Male
Female
Marital Status
State Licensed
Driver's License Number
Occupation
Date of Birth
Good Student
 
Driver 3
First Name
Last Name
Gender
Male
Female
Marital Status
State Licensed
Driver's License Number
Occupation
Date of Birth
 
Good Student
 
Driver 4
First Name
Last Name
Gender
Male
Female
Marital Status
State Licensed
Driver's License Number
Occupation
Date of Birth
 
Good Student

Vehicle 1
Year
Make
Model
VIN #
Miles per Year
Use of Vehicle
Number of miles one way
Owner-ship
 
Vehicle 2
Year
Make
Model
VIN #
Miles per Year
Use of Vehicle
Number of miles one way
Owner-ship
 
Vehicle 3
Year
Make
Model
VIN #
Miles per Year
Use of Vehicle
Number of miles one way
Owner-ship
 
Vehicle 4
Year
Make
Model
VIN #
Miles per Year
Use of Vehicle
Number of miles one way
Owner-ship

Vehicle Coverage
  Bodily Injury Property Damage
Personal liability
Towing & Labor
Yes
No
 
Uninsured motorist
Underinsured motorist  
Personal Injury Protection  

Accidents/Violations

Additional Information/Comments

Many insurance agencies use information gathered from you and outside sources about your claim, driving or credit history. This information helps insurance companies determine the proper quote.

Comanies that claim to get you a quote in 15 minutes or less, are placing speed over accuracy and personal attention is no longer part of the equation. First State Agency will not push you towards something you don't want or need, we will guide you.

By filling out this quote you agree to the above.