Online Insurance Service Request from thebestinsuranceagent.com

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Top 10 Reasons Why You Should Do Business With Insuring Minnesota!
1. You can be insured today!
2. Most quotes immediate on phone, others within 24 hours or the bext business day.
3. All policies come with a licensed Minnesota agent.
4. 20+ companies quoted.
5. Call us FREE! Our toll free number is: 1-800-972-4292 ext 425.
6. All our companies are rated "A-" or better by AM Best.
7. We think outside the box.
8. Free "no pressure" quotes.
9. Some of the Lowest rates in Minnesota
10. Low down and EASY monthly payment options.

"Service My Insurance" Account Request Form One Simple Form - takes only 2-3 Minutes! Your Personal Data
Your Name
Street Address:
City:
State:
Zip/Postal:
E-Mail (REQUIRED):
Phone (REQUIRED):
Fax: (Optional)

Policy & Service Details
Your Policy Number:


What do You Need?	Policy change Insurance Certificate Claim Assistance Other


Describe Your Service Need in DETAIL: (If you need a certificate of insurance, list name and complete address of certificateholder here.)

Please contact me for service via:	Fax E-Mail Regular Mail Please Call Me!

Thank you for filling out this form COMPLETELY!
We deem your data submitted as PRIVATE information. Every step has been taken to insure your privacy, security, and to release this information only to you. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release them from any liability should this information be accidentally viewed by others. Also, the insurance carriers reserve the right to issue coverage or not, and we cannot guarantee acceptance of a risk until approved by the company.
Yes, Please Service My Account. I Understand that NO COVERAGE IS BOUND on insurance changes until confirmed IN WRITING BY OUR AGENCY.

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thebestinsuranceagent.com - Insuring Minnesota
Phone: 952-469-0425 / Toll-Free: 800-972-4292 ext. 425 / Fax: 952-469-1881
E-Mail us at: info@insuringminnesota.com
20960 Holyoke Ave Lakeville, MN 55044