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SPECIALTIES: Auto & Home Insurance

RSI Agency, Inc - Phone: (651) 459-7005 - Locally Owned Agency Meeting All Your Personal & Commercial Insurance Needs

RSI Agency, Inc

Locally Owned Agency Meeting All Your Personal & Commercial Insurance Needs

745 High Street
Newport, Minnesota 55055

Phone: (651) 459-7005

RSI Agency, Inc Facility

RSI Agency, Inc, also provides home, motorcycle, and other recreational insurance policies in the Twin Cities area. Call us today for a quote at (651) 459-7005 or (651) 459-7006.


On-Line Automobile Insurance Quote Form
One Simple Form – only 2 or 3 minutes to complete!!


 

E-mail: rsi7005@yahoo.com
Hours of Operation:
Monday to Friday: 8:00 AM to 5:30 PM
Locally Owned

Your Independent Insurance Agent logo

RSI Agency, Inc*
*A division of Miller Hartwig Insurance
Address: 745 High Street
                 Newport, Minnesota 55055
Phone: (651) 459-7005, (651) 459-7006
Fax: (651) 459-1148

Your Personal Data

Your Name:

Street Address:

City:

State: (Must be Minnesota)

Zip Code:

E-Mail (REQUIRED):

E-Mail again for accuracy:

Phone:

Fax (optional):

Were You Referred to an Agent?

If Yes, Whom?

Marital Status:

Homeowner?

Currently insured? (lf yes, list carrier, and # of years continuous. If none, type N/C)

DRIVER INFORMATION #1

Name:

Sex

Birthdate:

Social Security #:

Number & Type of Accidents last 3 years:

Number & Type of MINOR violations last 3 years:

Number & Type of MAJOR violations last 3 years

MN Drivers License#:

Does Driver need an SR22 FILING?

If YES to SR22 filing, why needed? (list accident/cite)

DRIVER INFORMATION #2

Name:

Sex

Birthdate:

Social Security #:

Number & Type of Accidents last 3 years:

Number & Type of MINOR violations last 3 years:

Number & Type of MAJOR violations last 3 years

MN Drivers License#:

Does Driver need an SR22 FILING?

If YES to SR22 filing, why needed? (list accident/cite)

VEHICLE #1 INFORMATION
(If “Non-Owners”, type “NON-OWNER” in “YEAR” Field)

Year of vehicle:

Make & Model:

Vehicle ID# (for rating accuracy):

Annual Mileage:

Used in business? (Explain, if yes):

VEHICLE #1 COVERAGES:

Mention Liability Limits:

Mention Comprehensive Deductible:

Mention Collision Deductible:

Uninsured Motorists Coverage?

Rental Car & Towing Coverage?

Medical and/or PIP Coverage?

VEHICLE #2 INFORMATION
(If “Non-Owners”, type “NON-OWNER” in “YEAR” Field)

Year of vehicle:

Make & Model:

Vehicle ID# (for rating accuracy):

Annual Mileage:

Used in business? (Explain, if yes):

VEHICLE #2 COVERAGES:

Mention Liability Limits:

Mention Comprehensive Deductible:

Mention Collision Deductible:

Uninsured Motorists Coverage?

Rental Car & Towing Coverage?

Medical and/or PIP Coverage?

Comments or Remarks: (List additional drivers, autos, etc, here)

If more than 2 drivers, list Additional Driver’s Names, Birthdates and driving record history here:

Send my quotation via:

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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.

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SPECIALTIES: Auto & Home Insurance

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