Minnesota Commercial Auto Insurance Quote

We are your local St. Paul, Minnesota insurance agency, offering experienced
Commercial Business Auto 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 commercial auto insurance services in the remainder of Minnesota
and throughout Wisconsin.

**Information received from this Minnesota Commercial Auto 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 commercial
auto 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
Commercial Auto Insurance policy. We are licensed in Minnesota and Wisconsin and
will not provide quotes for other states.

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

Vehicle     Year              Make                Model             Body Type
     1
     2
     3

                Miles          Cost                                     Where              Lienholder      Lienholder
Vehicle   Driven         New            VIN#               Garaged              Yes/No             Name
     1
     2
     3

                      Liability                 Property                   Uninsured
Vehicle  Combined Limits          Damage               Combined Limits         Medical
     1
     2             SAME                       SAME                       SAME                   SAME
     3             SAME                       SAME                       SAME                   SAME

                   Collision         Comprehensive
Vehicle    Deductible           Deductible
     1
     2
     3

                                  Drivers                          Date of                                              Drivers
Driver                       Name                               Birth                  Gender                 License #
     1
     2
     3

Is each employee's driving record accident & violation free during the past 5 years?
Driver
     1       If No, how many accidents?    How many violations?
     2       If No, how many accidents?    How many violations?
     3       If No, how many accidents?    How many violations?

Was any employee's driver's license suspended during the past 5 years?
Driver
     1
     2
     3

Other Insurance Company Used Within Past 3 Years:
Policy #:
Any losses past 3 years:
Description of losses, including amount paid on each accident:

Additional Information or Comments

Click on the "Submit Quote Information" button below to send
your Minnesota Business Auto Insurance quote request.**