1st State Agency of
Sauk Centre, Minnesota, will contact you by phone within 3 business days.
Be prepared with your vin number.
| ATV | Snowmobile | Motorcycle | Watercraft |
| *Last |
|
| *First |
|
| *Middle |
|
| *Address |
|
| *City |
|
| *State |
|
| *Zip |
|
| *Home
Phone |
|
| Work
Phone |
|
| Fax |
|
| Email |
| Operator | First
Name |
|
| Last
Name |
||
| Gender |
Male Female |
|
| Marital
Status |
||
| State
Licensed |
||
| Driver's
License Number |
||
| Date
of Birth |
||
Years
Exp |
||
Accidents/Violations |
||
| Operator | First
Name |
|
| Last
Name |
||
| Gender |
Male Female |
|
| Marital
Status |
||
| State
Licensed |
||
| Driver's
License Number |
||
| Date
of Birth |
||
Years
Exp |
||
Accidents/Violations |
||
| Operator | First
Name |
|
| Last
Name |
||
| Gender |
Male Female |
|
| Marital
Status |
||
| State
Licensed |
||
| Driver's
License Number |
||
| Date
of Birth |
||
Years
Exp |
||
Accidents/Violations |
||
| Operator | First
Name |
|
| Last
Name |
||
| Gender |
Male Female |
|
| Marital
Status |
||
| State
Licensed |
||
| Driver's
License Number |
||
| Date
of Birth |
||
Years
Exp |
||
Accidents/Violations |
||
| Vehicle 1 | Year |
|
| Make |
||
| Model |
||
| VIN
# |
||
| CC's/Speed |
||
| Original
Cost |
||
| Value |
||
| Misc
Equipment |
||
| Vehicle 2 | Year |
|
| Make |
||
| Model |
||
| VIN
# |
||
| CC's/Speed |
||
| Original
Cost |
||
| Value |
||
| Misc
Equipment |
||
| Vehicle 3 | Year |
|
| Make |
||
| Model |
||
| VIN
# |
||
| CC's/Speed |
||
| Original
Cost |
||
| Value |
||
| Misc
Equipment |
||
BOAT INFORMATION ONLY
Power |
||
Type
of Hull |
||
| Hull
Material |
||
Hull
Design |
| Engine/Motor 1 | Year |
|
| Manufacturer/Model |
||
| Serial
# |
||
| HorsePower |
||
| Purchase
Date |
||
| Cost |
||
| Trailer | Year |
|
| Manufacturer/Model |
||
| Serial
# |
||
| Capacity |
||
| Purchase
Date |
||
| Cost |
||
Have any modifications been made to the vehicle/boat?
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. |