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If you would rather print out a form and mail or fax it, Click Here for Home or Renter or Condo!  Fax # 763-473-1344
Mail  2502 Morningside Rd., Long Lake, MN 55356

Type of Policy * -select one-RenterCondo OwnerPrimary HomeSeasonalRental Property

Applicants full name and birth date

E-mail Address: *

Property Address

Phone Number(s)

Claims in the last 5 years

Year built

Exterior - Type of siding

Fire hydrant within 1000 feet and fire department within 5 miles? -select one-yesno

Dogs? If yes, list breed(s)

Home Info

Style of Home - rambler, split, cape cod, etc.

List finished square feet/level (do not include garage)

Walkout basement? -select one-yesno

Garage: type and size

Bathroom: # full (shower &/or bath, sink, toilet)

Bathroom: # 1/2 (sink & toilet)

Deck - # and size

Porch - # and size

Fireplace - # and type (wood, gas)

Age of roof

When is your renewal or closing date? *

Verification Code:

Enter Verification Code: *

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