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02/08/2007

 

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Insurance or safety tip's could go here,

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Local weather for Grandin, Finley, etc

  
How Many Drivers will you be Insuring?

First Name

MI

Address 1
Address 2
City
State
Zip
Primary Phone
Email
Secondary Phone
   
 
Date of Birth
MM/DD/YYYY
Drivers Lic Number
State
Has Driver completed a Behind-the Wheel training course?
Does Driver qualify for a good Driver Discount?
3.0 GPA Required
Is Driver requires to file an SR-22?
In the past 5 years, has the drivers license been suspended or revoked?
In the past 5 years has driver had a DUI or DWI?
Highest Educational Level Completed
Please pick what best describes your occupation
Number of traffic tickets in the past 5 years
Number of At-Fault accidents in the past 5 years
Number Comprehensive claims in the past 5 years
Driver 2
 
Date of Birth
MM/DD/YYYY
Relationship to Primary Driver
   
Drivers Lic Number
State
Has Driver completed a Behind-the Wheel training course?
Does Driver qualify for a good Driver Discount?
3.0 GPA Required
Is Driver requires to file an SR-22?
In the past 5 years, has the drivers license been suspended or revoked?
In the past 5 years has driver had a DUI or DWI?
Highest Educational Level Completed
Please pick what best describes your occupation
Number of traffic tickets in the past 5 years
Number of At-Fault accidents in the past 5 years
Number Comprehensive claims in the past 5 years
       
Driver 3
 
Date of Birth
MM/DD/YYYY
Relationship to Primary Driver
   
Drivers Lic Number
State
Has Driver completed a Behind-the Wheel training course?
Does Driver qualify for a good Driver Discount?
3.0 GPA Required
Is Driver requires to file an SR-22?
In the past 5 years, has the drivers license been suspended or revoked?
In the past 5 years has driver had a DUI or DWI?
Highest Educational Level Completed
Please pick what best describes your occupation
Number of traffic tickets in the past 5 years
Number of At-Fault accidents in the past 5 years
Number Comprehensive claims in the past 5 years
     
Driver 4
 
Date of Birth
MM/DD/YYYY
Relationship to Primary Driver
   
Drivers Lic Number
State
Has Driver completed a Behind-the Wheel training course?
Does Driver qualify for a good Driver Discount?
3.0 GPA Required
Is Driver requires to file an SR-22?
In the past 5 years, has the drivers license been suspended or revoked?
In the past 5 years has driver had a DUI or DWI?
Highest Educational Level Completed
Please pick what best describes your occupation
Number of traffic tickets in the past 5 years
Number of At-Fault accidents in the past 5 years
Number Comprehensive claim's in the past 5 years
     
VEHICLE INFORMATION
How many vehicles will you be insuring?
   
Vehicle 1 information
Year
 
 
Make (example Ford)
 
    
Model (example: Ranger)
 
    
Number of Doors
 
    
Primary use of Vehicle
 
    
Zip code where vehicle is parked or garaged most:
 
    
Comprehensive Deductible:
 
 This is the amount you are willing to pay in the event of a claim other than an accident. Examples include break-ins and weather damage. The higher the deductible, the lower the cost of the insurance. Finance companies require that you carry comprehensive insurance if you have financed your car and are still making payments.
Collision Deductible:
 

This is the amount you are willing to pay in the event of an accident. The higher the deductible, the lower the cost of the insurance. Finance companies require that you carry comprehensive insurance if you have financed your car and are still making payments.

If you commute, number of days and miles per week you commute:
 

days per week and miles per day

Approximately how many miles is the vehicle driven per year:
 
 annually  
Is the vehicle leased?
 
    
Who drives the vehicle most:
 
    
     
Vehicle 2 information
Year
 
Make (example Ford)
 
    
Model (example: Ranger)
 
    
Number of Doors
 
    
Primary use of Vehicle
 
    
Zip code where vehicle is parked or garaged most:
 
    
Comprehensive Deductible:
 

This is the amount you are willing to pay in the event of a claim other than an accident. Examples include break-ins and weather damage. The higher the deductible, the lower the cost of the insurance. Finance companies require that you carry comprehensive insurance if you have financed your car and are still making payments.

Collision Deductible:
 

This is the amount you are willing to pay in the event of an accident. The higher the deductible, the lower the cost of the insurance. Finance companies require that you carry comprehensive insurance if you have financed your car and are still making payments.

If you commute, number of days and miles per week you commute:
 

days per week and miles per day

Approximately how many miles is the vehicle driven per year:
 
 annually
Is the vehicle leased?
 
    
Who drives the vehicle most:
 
    
Vehicle 3 information
Year
 
Make (example Ford)
 
    
Model (example: Ranger)
 
    
Number of Doors
 
    
Primary use of Vehicle
 
    
Zip code where vehicle is parked or garaged most:
 
    
Comprehensive Deductible:
 

This is the amount you are willing to pay in the event of a claim other than an accident. Examples include break-ins and weather damage. The higher the deductible, the lower the cost of the insurance. Finance companies require that you carry comprehensive insurance if you have financed your car and are still making payments.

Collision Deductible:
 
 This is the amount you are willing to pay in the event of an accident. The higher the deductible, the lower the cost of the insurance. Finance companies require that you carry comprehensive insurance if you have financed your car and are still making payments.
If you commute, number of days and miles per week you commute:
 

days per week and miles per day

Approximately how many miles is the vehicle driven per year:
 

annually
Is the vehicle leased?
 
    
Who drives the vehicle most:
 
    
     
Vehicle 4 information
Year
 
Make (example Ford)
 
    
Model (example: Ranger)
 
    
Number of Doors
 
    
Primary use of Vehicle
 
    
Zip code where vehicle is parked or garaged most:
 
    
Comprehensive Deductible:
 
 This is the amount you are willing to pay in the event of a claim other than an accident. Examples include break-ins and weather damage. The higher the deductible, the lower the cost of the insurance. Finance companies require that you carry comprehensive insurance if you have financed your car and are still making payments.
Collision Deductible:
This is the amount you are willing to pay in the event of an accident. The higher the deductible, the lower the cost of the insurance. Finance companies require that you carry comprehensive insurance if you have financed your car and are still making payments.
If you commute, number of days and miles per week you commute:
days per week and miles per day
Approximately how many miles is the vehicle driven per year:
 

annually
Is the vehicle leased?
 
    
Who drives the vehicle most:
 
    

 

 




  
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Information about what's coming up for example Big Iron, Golf Outing, and any other events you may be attending.

 
      Locations
  Grandin ND

(701) 484-5555
800-690-5556
Fax: (701) 484-5521
 

Finley ND

 

Colgate ND

 
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  Whatever you want cane be added here