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223 1st St East, Ste 100
Jordan, Minnesota 55352
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952-492-2300
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Vehicle 1

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Comprehensive Deductible:
Collision Deductible:
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Vehicle 3

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Passive Restraints:
Anti-Lock Brakes:
Daytime Running Lights:
Any Prior Damage to Vehicle?
Vehicle Ever Used for Deliveries?
Comprehensive Deductible:
Collision Deductible:
Full Glass Coverage?

Vehicle 4

Vehicle 4 Year:
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Anti Theft Features:
Passive Restraints:
Anti-Lock Brakes:
Daytime Running Lights:
Any Prior Damage to Vehicle?
Vehicle Ever Used for Deliveries?
Comprehensive Deductible:
Collision Deductible:
Full Glass Coverage?

Vehicle 5

Vehicle 5 Year:
Vehicle 5 Make:
Vehicle 5 Model:
Vehicle 5 VIN:
Primary Driver:
Current Odometer:
Estimated Yearly Mileage:
Ownership:
Primary Use:
Anti Theft Features:
Passive Restraints:
Anti-Lock Brakes:
Daytime Running Lights:
Any Prior Damage to Vehicle?
Vehicle Ever Used for Deliveries?
Comprehensive Deductible:
Collision Deductible:
Full Glass Coverage?
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Insurance Brokers of Minnesota

223 1st St East, Ste 100
Jordan, MN 55352
 952-492-2300
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Located in Jordan, Minnesota. We also serve the Chaska, Minneapolis, Prior Lake, Savage, and Shakopee areas. - Licensed in Minnesota and  Wisconsin

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