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This is a request for a Minnesota commercial insurance quote, not a policy application. Submitting this form does not obligate you to purchase any commercial insurance products. Please complete this form as accurately as possible. Commercial insurance rates are subject to change.

Contact Information

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Company Name
Street
City, State ZIP

E-mail
Phone
Fax

Company & Insurance Information

Form of Business
Years in Business
Effective Date Needed
Current Insurance Company

Coverage's Requesting Quote On

Property General Liability
Business Auto Umbrella
Truckers Equipment
Garage/Dealers Electronic Data Processing
Transportation/Motor Truck Carrier Glass & Sign
Workers Compensation Boiler & Machinery
Accounts Receivable/Valuable Papers Crime
Installation/Builders Risk Bond
Kidnap & Ransom Employment Practices

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Since 1978
Michael W. Smith Agency

Copyright © 2000 Michael W. Smith Agency
Last modified: April 06, 2008