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E-Mail:
info@insuring
minnesota.com

Phone Lines:
1-800-972-4292
ext. 425
1-952-469-0425

Fax:
1-952-469-1881

Mailing Address:
20960 Holyoke Ave
PO Box 1177
Lakeville, MN
55044

MN Insurance
License #:

44761

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On-Line Special Event
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!

Your Personal / Company Data:

Your Name:
Your Company's Name:
Street Address:
City:
State: (Must be Minnesota)
Zip/Postal:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 
Event Details
Date(s) of Event:
Describe Event in DETAIL:
Event Location (address):
 
Number in attendance:
 
Will food be served? Yes No
If yes to food, describe:
 
Will Alcochol be served? Yes No
If yes to alcohol, describe:
 
Describe security at event:
 
Describe music if any, at event:
 
Is There a Charge to Get In
(called a "cover charge")?
Yes No
 
If charge, estimate receipts: $
 
Approximate square footage
of location you are using:
 
Name and Address of
Additional Insured, if any
(usually the facility):
 
Send my quotation via: E-Mail Fax
Regular Mail
Please Call by Phone!

 
Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below 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.

Yes, I Agree. Please Send Me a
Special Event Quote NOW!

Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!

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