Car - Bob Meyer Insurance Lakeville, Minnesota

Minnesota Trusted Choice Insurance Professionals!

Bob Meyer and his Staff provide Auto, Home, Life, Health, & Business Insurance for Lakeville, Farmington, Eagan, Apple Valley, Burnsville, and the Greater Minneapolis/St. Paul Area of Minnesota. Representing over 20 quality insurers for the best value and choice in insurance protection.

Representing Minnesota's Leading Trusted Choice Insurers!

Minnesota Auto Insurance Quote Request

One Simple Form - takes less than 5 minutes

Items marked with an asterisk (*) are required questions.

Car Insurance Quote Request Form


Your Legal Name:*
Street Address*
City or Town:*
State:*
Zip Code:*
E-Mail*
E-Mail (again for accuracy):*
Phone:*
Fax: (Optional)
Marital Status:*	Single Married
Homeowner:*	Yes No
How Long at Present Address?*	Less than 3 years More than 3 years
Currently Insured:*
Current Auto Insurer If Applicable
Name of Driver #1:*
Sex:*	Male Female
Birthdate Driver #1*
Drivers License # for Driver #1:*
Drivers License what STATE:*
Social Security Number:
Occupation, state if unemployed, or retired:*
Years of Education for Driver #1:
Number of Accidents last 5 years:*
Number of MINOR violations last 5 years:*
Number of MAJOR violations last 5 years:*
Senior Defensive Driver Course Credit (Must be 55 or older):	Yes No
Name of Driver # 2
Sex:	Male Female
Birthdate, Driver #2:
Drivers License Number, Driver #2:
Drivers License State, Driver #2:
Social Security Number Driver #2:
Occupation Driver #2, state if unemployed or retired:
Years of Education:
Number of Accidents last 5 years:
Number of MINOR Violations last 5 years:
Number of MAJOR Violations last 5 years:
Senior Defensive Driver Course Credit (Must be 55 or older):	Yes No
Vehicle #1 Model Year:*
Veh #1 Make & Model:*
Vehicle #1 Vehicle ID #:
Select Liability Limits
Personal Injury Protection MN Only (All Vehicles):
Select Collision Coverage:
Select Comprehensive Coverage Option:
Full Glass Coverage? (Must also have Comprehensive Coverage):	Yes No
Rental Car Coverage?	Yes No
Daily commute in ONE WAY miles, type 0 if not commuting, B for Business Use:
Vehicle #2 Model Year:
Vehicle #2 Make & Model:
Vehicle #2 Vehicle ID #:
Select Liability Limits:
Select Collision Coverage Option:
Select Comprehensive Coverage Option:
Full Glass Coverage? (Must also have Comprehensive Coverage):	Yes No
Rental Car Coverage?	Yes No
Daily Commute in ONE WAY Miles, type 0 if not commuting, B for Business Use:
Comments or Remarks (list additional drivers, autos, etc. here):
Permission Requested - Required to check driving records, loss history, and insurance scoring.*
Would you like a Home or Renters Quote and reduce your auto premiums?	Yes No
Would you like an Umbrella/Excess Liability Quote?*	Yes No Unsure - Send me information.
Send us a copy of your insurance to compare:

Thank you for filling out this form COMPLETELY!

You should know: Agents and Insurance Companies must check your driving record, history of losses, and run your insurance score to obtain your auto insurance quote. Insurance scores are unique for each company with some carriers giving discounts of up to 50% for those with exceptional credit. So what is insurance scoring? Learn More!

By submitting this form, your are giving your permission.

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote results only to you. We will not give your data to any other person or group for sales, marketing, or for any other purpose. By requesting a quote 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.

Bob Meyer of Miller-Hartwig Insurance. Your Trusted Choice Insurance Agent.