Germain Insurance Agency - Request Auto Quote

Request an Auto Quote

If you would like a quote please call one of our locations or email us your information. For quotes on other insurance products, please call to speak to an agent directly. If you wish to contact us by email, please fill out the following information. Please be aware we will need to contact you by phone to get further information to confirm quotes. This is not a secure website.

Germain Insurance Agency
315 West 46th Street
Minneapolis, MN 55419
Phone: (612) 822-7983
Fax: (612) 822-8734
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OWNER OF VEHICLE/NAME INSURED
First:
MI:
Last:
Age:
Marital Status:
ADDITIONAL DRIVERS/HOUSEHOLD MEMBERS 1st Member
First:
MI:
Last:
Age:
Marital Status:
2nd Member
First:
MI:
Last:
Age:
Marital Status:
3rd Member
First:
MI:
Last:
Age:
Marital Status:
VEHICLE INFORMATION 1st Vehicle
Year:
Make:
Model:
# of Doors:
2WD/4WD:
Zip Code Where Garaged/Stored:
2nd Vehicle
Year:
Make:
Model:
# of Doors:
2WD/4WD:
Zip Code Where Garaged/Stored:
3rd Vehicle
Year:
Make:
Model:
# of Doors:
2WD/4WD:
Zip Code Where Garaged/Stored:
4th Vehicle
Year:
Make:
Model:
# of Doors:
2WD/4WD:
Zip Code Where Garaged/Stored:
CURRENT INSURANCE INFORMATION
Name of Current Insurance Company:
Effective Date of Policy (dd/mm/yyyy):
Expiration/Cancellation Date of Policy (dd/mm/yyyy):
Current Limits of Liability:
Current Deductible Values:
Do you pay in full or make monthly payments?
Do you have current home or renters insurance?
Please list any traffic violations or accidents including date of incedent in the last 5 years for any listed driver:
Please list and describe any damage on the vehicle:
CONTACT INFORMATION:
Phone number where you can be reached:
Email Address:
Click text to edit:
Best time to call: