Midland Insurance Group

home Homeowners Insurance Quote Fax Form

Please print this form, fill in the information, and fax it to
(320) 485-2199

Also, fax us a copy of your current Homeowners Coverage Policy Page
and a list of scheduled items.
This will allow us to determine your fire rating, liability limits, and deductible.

Name

 _______________________________________________________

Phone number
with area code

 _______________________________________________________

Best time to call

 _______________________________________________________


Thank You!
We will contact you soon!

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