Insurance
Kullen Stanek - Owner
Wanda Scharfe - Licensed CSR
Real Estate
Kullen Stanek - Broker
Karen Koster - Salesperson
Insurance Quote
If you would like to receive a free insurance quote, please complete the information below.
As much information as you are able to provide will help us to accurately quote your insurance.
Once you submit this completed form, the information will be received by us. We will then contact you and provide you with a free quote
Please note that fields marked with an '*' are required and must be present for a valid submission.
Contact Information
*Name
*Address
*City
*State
*Zip Code
*Phone#
*Email
Please select which types of quotes you would like and complete the information that appears below:
Auto Quote
Homeowners Quote
Auto Quote Information
DRIVER(S) TO INSURE
Enter the names, birth dates, and other information for each of the drivers that you want to insure.
DRIVER# 1
Driver's Name
Date of Birth
Social Security #
Relationship
Driver's License #
Good Student Discount
Accident Prevention Course Discount
List any Tickets/Accidents/Claims below
DRIVER# 2
Driver's Name
Date of Birth
Social Security #
Relationship
Driver's License #
Good Student Discount
Accident Prevention Course Discount
List any Tickets/Accidents/Claims below
DRIVER# 3
Driver's Name
Date of Birth
Social Security #
Relationship
Driver's License #
Good Student Discount
Accident Prevention Course Discount
List any Tickets/Accidents/Claims below
DRIVER# 4
Driver's Name
Date of Birth
Social Security #
Relationship
Driver's License #
Good Student Discount
Accident Prevention Course Discount
List any Tickets/Accidents/Claims below
VEHICLE INFORMATION
Please tell us about the vehicles you wish to have insured
VEHICLE# 1
Vehicle Type
Automobile
Motorcycle
Year
Make
Model
VIN #
Use
Pleasure
Farm
Drive to Work
# Miles One Way
VEHICLE# 2
Vehicle Type
Automobile
Motorcycle
Year
Make
Model
VIN #
Use
Pleasure
Farm
Drive to Work
# Miles One Way
VEHICLE# 3
Vehicle Type
Automobile
Motorcycle
Year
Make
Model
VIN #
Use
Pleasure
Farm
Drive to Work
# Miles One Way
VEHICLE# 4
Vehicle Type
Automobile
Motorcycle
Year
Make
Model
VIN #
Use
Pleasure
Farm
Drive to Work
# Miles One Way
CURRENT COVERAGE
If currently insured, what coverage does your policy currently offer?
Insurance Company
Current Premium
Bodily Injury Limits
(e.g. 100/300)
Property Damage
(e.g. 100)
Uninsured Motorists
(e.g. 100/300)
Underinsured Motorists
(e.g. 100/300)
Towing Coverage
Yes
No
Rental Coverage
Yes
No
DEDUCTIBLE INSURANCE
If currently insured, what deductibles does your policy currently offer?
Vehicle 1:
Comprehensive
Collision
Full Glass
Vehicle 2:
Comprehensive
Collision
Full Glass
Vehicle 3:
Comprehensive
Collision
Full Glass
Vehicle 4:
Comprehensive
Collision
Full Glass
Additional Remarks
Homeowners Quote Information
Style
1 Story
1.5 Story
2 Story
Split Entry
Multi-Level
Year Built
Dimensions
Garage
Detached
1 Stall Attached
2 Stall Attached
3 Stall Attached
Bath(s)
Full
None
1
2
3
4
Half
None
1
2
3
4
Basement
% Finished
Exterior
Aluminum
Brick
Steel
Stucco
Vinyl
Wood
Roof
Age
Type
Asphalt
Steel
Wood
Deck Dimensions
Heat
Age
Source
Electric
Fuel Oil
LP
Natural Gas
Central Air
Yes
No
Solid Fuel
Yes
No
CURRENT COVERAGE
If currently insured, what coverage does your policy currently offer?
Insurance Company
Current Premium
Current Coverage Amount
Current Deductible
Liability Limits
Medical Payments
Additional Remarks
Beck Agency Inc
Insurance & Real Estate
130 North Tyler Street
Tyler, MN 56178
Phone: 507-247-5581
Toll Free: 800-492-7872
Fax: 507-247-5582
info@beckagencyinc.com
Send mail to
dblowers@starpoint.net
with questions or comments about this web site.
Last modified: 10/16/07