logo for bates insurance group, an independent insurance agency in eden prairie minnesota

For All Your Insurance Needs...Think BIG!

952-944-5044

Toll Free: 800-728-8745

MN Auto Insurance Quote

Get the best price quote for MN Auto Insurance by filling out this form.

Contact Info


Name:*
Phone:
-
E-mail:*
Street Address:*
Date of birth:*

Driver Information

Number of drivers:
Driver #1 Name:*
Driver #1 Date of Birth:*
Driver #1 License Number:*
Driver #2 Name:
Driver #2 Date of Birth:
Driver #2 License Number:
Driver #3 Name:
Driver #3 Date of Birth:
Driver #3 License Number:
Driver #4 Name:
Driver #4 Date of Birth:
Driver #4 License Number:
Driver #5 Name:
Driver #5 Date of Birth:
Driver #5 License Number:

Vehicle Information


Number of Vehicles:
Vehicle #1 - VIN or Make, Model, and Year:
Vehicle #2 - VIN or Make, Model, and Year:
Vehicle #3 - VIN or Make, Model, and Year:
Vehicle #4 - VIN or Make, Model, and Year:
Vehicle #5 - VIN or Make, Model, and Year:

Policy Information


Renewal Date:
Comprehensive Deductible:
Liability Limit/s:
Collision Deductible:
PIP Stacking?
Towing & Labor?

Claims History


Use the field below to enter any detail regarding recent claims history for any of the drivers listed above: