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    Minnesota Insurance Center.com
    PO Box 1177 Lakeville, MN 55044
    Phone: 952-469-0425 | Fax: 952-469-1881
    Email Us Your Questions: Customer Service
    • Valuable Articles, Fine Arts
    & Collectibles Insurance Quote
    One Simple Form - takes only 2-3 Minutes!
    Your Name:
    Property Address:
    City:
    State: (Must be Minnesota)
    Zip/Postal:
    E-Mail (REQUIRED):
    E-Mail (again for accuracy):
    Phone:
    Fax (optional):
     
    Underwriting Information
     
    Describe Fine Arts/Collectibles:
    (List 1 item per line and dollar
    value next to each)
     
    Where are Collectibles kept?:
     
    Number of residents in household?:
     
    Number of miles from nearest fire station?:
     
    Central Station Alarm? Yes No
     
    Deadbolt locks on all exterior doors? Yes No
     
    Wallsafe on Premises? Yes No
     
    Are any items kept away from premises, loaned or on exhibit?
    (If yes, explain below in remarks)    		 Yes No
    Remarks:
     
    Co you have current appraisals on these items?
    (Please tell when last appraisals were done in appraisal comments)    		 Yes No
    Appraisal Comments:
     
    Currently Insured? Yes No
    Name of Carrier & how long insured?
     
    Prior Claims? Yes No
    Describe claims in detail:
     

    Coverages:
     
    Fine Arts $ Other Collectibles $
     
    Amount
    In-Vault $     		Amount
    Off-Premises $
     
    Deductible Desired:
    ($250, $500, $1,000, etc.)    		 $
     
    Comments/Remarks:
     
    Send my quotation via: E-Mail Fax
    Regular Mail

    Thank you for filling out this form COMPLETELY!

    We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow Basic West Insurance Agency to release this information via the method you have chosen, and to release them from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

    Yes, I Agree. Please Send Me a Quote NOW!

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