MN Group Life Insurance Quote

Group Term Life Insurance Coverage Information:

Employee Information:

Business Name:
Premises Address:
City:
State: (Minnesota or Wisconsin)     Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required)
Description of Operations or SIC code:

Current Insurance Company:
Policy Expiration Date:          (mm/dd/yyyy)

Group Term Life Insurance Objective:
Amount of Life Insurance Desired Per Employee:    Other Amount:$

How many employees to be insured:

Did any employee to be insured have health problems during
the past 18 months?
If "Yes", please list information below.

Does any employee to be insured have a hazardous job? Yes No
If Yes, how many have hazardous jobs?

Are any employees to be insured active members of the military reserves? Yes No
If Yes, how many are active members of the military reserves?

Additional Information or Comments

Click on the "Submit Quote Information" button below to
send your Minnesota Group Life insurance quote request.**

Minnesota Business Information:

We are your local St. Paul, Minnesota insurance agency, offering experienced
Group Life Insurance services to businesses in the following Twin Cities area
towns and counties: Minneapolis, Bloomington, Roseville, Maplewood, North
St. Paul, Oakdale, Woodbury, Cottage Grove, South St. Paul, Inver Grove
Heights, Eagan, West St. Paul, Richfield, Burnsville, Edina, Lilydale, Mendota
Heights, St. Paul Park, Lake Elmo, Newport, Cedar Grove, Savage, Shakopee,
Eden Prairie, Minnetonka, Hopkins, St. Louis Park, Plymouth, Golden Valley,
Columbia Heights, New Hope, Crystal, Robbinsdale, Brooklyn Center, Fridley,
New Brighton, Maple Grove, St. Anthony, Arfen Hills, Shoreview, Vadnais
Heights, Little Canada, White Bear Lake, Mahtomedi, Grant, Bellaire, North
Oaks, Gem Lake, Mounds View, Lino Lakes, Blaine, Coon Rapids, Spring Lake
Park, Lexington, Afton, Lakeland, Bayport, Stillwater, Apple Valley, Andover,
St. Cloud, Mankato, Rochester, Duluth, Anoka, Champlin, Andover, Oak Grove,
St. Michael, Hanover, Scandia, Forest Lake, Wyoming, Rosemount, Hastings,
Vermillon, Coates, Ramsey County, Hennepin County, Dakota County, Anoka
County, and Washington County, MN. We also offer business insurance
services in the remainder of Minnesota and throughout Wisconsin.

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Baecker Insurance Agency, Inc.

373 Pedersen Street, Suite 104

St. Paul, Minnesota 55119

Ramsey County, MN

(651) 730-6666

Toll Free: 1-877-730-4678

**Information received from this Group Life Insurance quote request form sent
to the Baecker Insurance Agency will be for our use only and will not be sold,
given to or distributed to any other parties. A quote will be based on the group
life insurance policy information provided and does not guarantee acceptance
of the risk by us. The precise coverage afforded is subject to meeting
underwriting guidelines, and the terms, conditions and exclusions of the policy
as issued. By submitting this request you acknowledge that this is neither an
offer to insure nor a guarantee of insurance. Completion of this form does not
entitle your business to a Minnesota Group Life Insurance Policy. We are
licensed in Minnesota and Wisconsin and will not provide quotes for other
states.

Minnesota Group Life

Insurance Quote

Proudly serving all of Minnesota
and Wisconsin for over a decade!

In addition to Busines Group
Life Insurance, we also offer
affordable Group Health
Insurance plan services.

Baecker Insurance Agency
of Saint Paul, MN offers
affordable Business Insurance
coverage options and
experienced business insurance
services throughout
Minnesota.

Contact us about Property,
Liability, Owners, Auto, and
Workers Comp Insurance for
your Minnesota business toll
free at 1-877-730-4678 or
locally at (651) 730-6666.

Group Life Insurance Specialists