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

*Business Name
 
 
*Mailing Address
*City
*State
*Zip
*Home Phone
*Business Phone
Website
Fax
Email
Date Business Started
Number of Employees
Inspection Contact
Accounting Contact
FEIN (if available)

Mailing Address if different from above
Business Location Address
City
State
Zip

Premises Information

Location 1
Address
City Limits
Owner
Year Built
Construction
Part Occupied
 
Location 2
Address
City Limits
Owner
Year Built
Construction
Part Occupied
   
   
   
 
Driver
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

Nature of Business/ Description of Operation by Premise(s)

Remarks/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.