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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
  
Number of people to be covered:
Your Name:
Email:
Address:
City:
State: Zip:
Day Phone:
Evening Phone:
Fax:
Contact me by: Phone Email Mail Fax
Name of Person 1 to be covered?
Date of Birth:
Sex: Male  Female
Tobacco User? Yes  No
Ongoing Health Problems? Yes  No
Deductible Desired:
Additional Comments:
 
     
 


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