Office
102 Main St South
Hutchinson, MN 55350
Phone: 320-587-2674
Toll: 888-234-2910
info@ciahutch.com

Hours
Mon-Thurs: 8:30am–5pm
Fri: 8:30–4pm
Other times by appointment.

Auto Insurance Quote

Name:
Address:
City:
State:
Zip:
County:
Email:
Home Phone:
Work Phone:
When can we contact you?	Day Evening
Current Carrier:
Policy Number:

Driver #1
Name:
Marital Status:
Sex:
DOB:
Driver's License:
SSN:
Principal Vehicle:
Tickets/Accidents:

Driver #2
Name:
Marital Status:
Sex:
DOB:
Driver's License:
SSN:
Principal Vehicle:
Tickets/Accidents:

Driver #3
Name:
Marital Status:
Sex:
DOB:
Driver's License:
SSN:
Principal Vehicle:
Tickets/Accidents:

Driver #4
Name:
Marital Status:
Sex:
DOB:
Driver's License:
SSN:
Principal Vehicle:
Tickets/Accidents:

Vehicle #1
Make/Model:
Year:
Serial Number:
ALB:	yes no
Airbags:	yes no
If yes, how many?
Do you have?	Lessor Lienholder Add'l Insured
Name of above:
Usage:	Pleasure: 0-3 mi daily Business
	Commute: 3-15 mi daily Commute: over 25 mi daily

Vehicle #2
Make/Model:
Year:
Serial Number:
ALB:	yes no
Airbags:	yes no
If yes, how many?
Do you have?	Lessor Lienholder Add'l Insured
Name of above:
Usage:	Pleasure: 0-3 mi daily Business
	Commute: 3-15 mi daily Commute: over 25 mi daily

Vehicle #3
Make/Model:
Year:
Serial Number:
ALB:	yes no
Airbags:	yes no
If yes, how many?
Do you have?	Lessor Lienholder Add'l Insured
Name of above:
Usage:	Pleasure: 0-3 mi daily Business
	Commute: 3-15 mi daily Commute: over 25 mi daily

Vehicle #4
Make/Model:
Year:
Serial Number:
ALB:	yes no
Airbags:	yes no
If yes, how many?
Do you have?	Lessor Lienholder Add'l Insured
Name of above:
Usage:	Pleasure: 0-3 mi daily Business
	Commute: 3-15 mi daily Commute: over 25 mi daily

Coverage Amounts - Vehicle #1
Vehicle:
Liability:
PIP/MED:
UM/UIM:
Coll Ded:
Comp Ded:
Rental:
Towing:
Misc:

Coverage Amounts - Vehicle #2
Vehicle:
Liability:
PIP/MED:
UM/UIM:
Coll Ded:
Comp Ded:
Rental:
Towing:
Misc:

Coverage Amounts - Vehicle #3
Vehicle:
Liability:
PIP/MED:
UM/UIM:
Coll Ded:
Comp Ded:
Rental:
Towing:
Misc:

Coverage Amounts - Vehicle #4
Vehicle:
Liability:
PIP/MED:
UM/UIM:
Coll Ded:
Comp Ded:
Rental:
Towing:
Misc:

Liability, PIP (Personal Injury Protection), Unisured Motorist and Underinsured Motorist coverages are required. Minimum Liability is 30/60/10, Minimum UM/UIM is 25/50, PIP is 20/20. Collision, Comprehensive, Car Rental and Towing are optional coverages. You may leave the Coverage Amount section blank and trust our expertise to build you a quote based on the driver and vehicle information you provide.

	View our privacy policy.