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     Billmark's Lakes Area Insurance, Inc. • 320-763-9022 • 888-763-9022      ABOUT US | CONTACT US | HOME
       
 
   
  Billmark's Lakes Area
Insurance Inc.
913 Broadway Street
Alexandria MN 56308
888-763-9022 toll free
320-763-9022 phone
320-763-3548 fax
 
 
  Lakes Area Insurance
105 Central
PO Box 567
Brandon MN 56315
320-524-2525 phone
320-834-2409 fax
  

Fill out the form below to obtain a free auto insurance quote from the professionals at Billmark's Lakes Area Insurance, Inc.

Select the number of vehicles to insure:
Select the number of drivers to insure:
Fields in bold are required.
Name:
Address:
City:
State: Zip:
Day Phone:
Evening Phone:
Fax:
Email:
Best time to reach you: Mornings   Afternoons   Evenings
Best way to reach you: Home Phone   Work Phone   Email   Fax
Current Insurance Company:
Vehicle Number 1
Year: Make: Model:
Click all that apply: Anti-Lock Brakes  Air Bags  Auto Seat Belts  Alarm
How do you use the vehicle?   Business   Farm   Pleasure   Work
Do you use your vehicle for work?   Yes   No    
    If yes, number of miles to work one way:
How many actual miles do you put on this vehicle per year?
Current liability coverage:
Comprehensive Deductible:
Collision Deductible:
Personal Injury Protection: Basic Add'l          Stacked? Yes No
Full Glass Coverage? Yes No          Towing? Yes No
Driver Number 1
Full Name:
Date of Birth: Male Female
Driver's License Number:
Number of Years Licensed:
Vehicle Driven Most Often:
Marital Status: Single Married Divorced Widowed
Custody of Child: Yes No Not Applicable
Good Student Discount? Yes No
55 Alive Course? Yes No
Any "Not at Fault" accidents within last 3 years? Yes No
    If yes, how many?          Claim Dollar Amount
Any "At Fault" accidents within the last 3 years? Yes No
    If yes,  Claim Dollar Amount
Any tickets or violations within the last 3 years? Yes No
    If yes, what type?
Principal Vehicle Driven:

Additional Comments:

     
 


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