Services for Real Estate Pros	RAINER 2,612
	Ron Davis
	location_on Elkhart, IN — Brooke Insurance
	insert_link http://www.quoteinaflash.com
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We are an independent insurance agency that is dedicated to working for you. We can help you gain control of your insurance expenses. We represent a variety of stable, creditable, and nationally recognized insurance carriers. As an independent agency we can provide our clients with full protection and value by comparing a number of carriers for each individual need. Securing multiple coverages through Brooke could simplify your life while saving you money! With many years of experience in the insurance industry, We can help you make informed decisions about your coverage

This agency will strive to offer quality insurance coverage, a high-level of professional service and a long-term relationship to our customers. We will strive to represent ethical, quality insurance carriers and provide loyal, dependable representation. As an agency, we are challenged to accomplish this with skilled management, experience, teamwork, and constant improvement in knowledge and skills.

            This agency will strive to offer quality insurance coverage, a high-level of professional service and a long-term relationship to our customers. We will strive to represent ethical, quality insurance carriers and provide loyal, dependable representation. As an agency, we are challenged to accomplish this with skilled management, experience, teamwork, and constant improvement in knowledge and skills.  We are an independent insurance agency that is dedicated to working for you. We can help you gain control of your insurance expenses. We represent a variety of stable, creditable, and nationally recognized insurance carriers. As an independent agency we can provide our clients with full protection and value by comparing a number of carriers for each individual need. Securing multiple coverages through Brooke could simplify your life while saving you money! With many years of experience in the insurance industry, We can help you make informed decisions about your coverageGET A FREE QUOTE!

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Michigan, Indiana

  - Auto - Boat/Watercraft - Business - Commercial - Disability - Farm/Ranch - Homeowners - Life/Health - Motorcycle - Umbrella We have access to numerous insurance companies that allows us to find the right plan to fit your individual needs while keeping your costs down. We will strive to represent ethical, quality insurance carriers and provide loyal, dependable representation. Below are just a few of the insurance companies that Brooke Insurance agencies utilize when shopping your insurance rates. (Your local agency may not have access to all of these carriers, each location has access to a different company mix of the over 500 insurance companies the Brooke Franchise Corporation has relationships with.) • Victoria• Travelers• AIG• Safeco• MetLife• Progressive• Bristol West• Dairyland• Viking• Allied• Fidelity• Vision• Foremost• Farmers• The Hartford• Affirmative• Arrowhead• GMAC• CSE• Unitrin• Mexi-Pass• Infinity• Chubb• American Modern• Liberty Mutual

 

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Auto Quote Request FormABOUT SSL CERTIFICATES   * = Required FieldsContact Information* Todays Date:(mm/dd/yyyy) * First Name: * Last Name: * Street Address: * City:* State:AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY* Zip:* County:* Home Phone:(999-999-9999)* Work Phone:(999-999-9999) * Email:* Are you currently (or have you ever been) a Brooke customer? Yes No* How did you hear about Brooke? Driver Information Driver #1 * Name:* Date of Birth:(mm/dd/yyyy) * Gender:Male Female* Marital Status: Single Married Divorced Separated Widowed* Residence:Own Rent Live With Parents Other* Relationship to Driver#1: Social Security Number:(e.g. 555-55-5555) * Drivers License Number: * At what age did this driver first receive their license?: * Has this driver been a U.S. or Canadian resident for the past 12 months?: Yes No* Has this driver completed Behind-the-Wheel in the last 5 years?: Yes No* Is this driver a full-time student with GPA of 3.0 or above?:Yes No* In the past 5 years, has the driver's license been suspended or revoked?: Yes No* Does the driver require an SR-22 or Financial Responsibility Statement?: Yes No* In which state is this driver currently licensed?:AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY* What is the driver's highest education level?:Some or No High School High School Diploma G.E.D. Associates Degree Bachelors Degree Masters Degree Doctorate Other* Past or Present Military Experience?: No Military Experience Active Commissioned Active Enlisted Discharged Commissioned Discharged Enlisted Reserved Commissioned Reserved Enlisted Retired Other* What is your occupation?: * How long have you been with your occupation?: * In the past 5 years have you filed for bankruptcy?: Yes No* In the past 5 years have you had any repossessions, charge offs, or collections?: Yes No* How would you describe your credit rating?: Poor Good ExcellentUnsureDriver #2Name:Date of Birth:(mm/dd/yyyy) Gender:Male FemaleMarital Status: Single Married Divorced Separated WidowedResidence:Own Rent Live With Parents OtherRelationship to Driver#1: Social Security Number:(e.g. 555-55-5555) Drivers License Number: At what age did this driver first receive their license?: Has this driver been a U.S. or Canadian resident for the past 12 months?: Yes NoHas this driver completed Behind-the-Wheel in the last 5 years?: Yes NoIs this driver a full-time student with GPA of 3.0 or above?:Yes NoIn the past 5 years, has the driver's license been suspended or revoked?: Yes NoDoes the driver require an SR-22 or Financial Responsibility Statement?: Yes NoIn which state is this driver currently licensed?:AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WYWhat is the driver's highest education level?:Some or No High School High School Diploma G.E.D. Associates Degree Bachelors Degree Masters Degree Doctorate OtherPast or Present Military Experience?: No Military Experience Active Commissioned Active Enlisted Discharged Commissioned Discharged Enlisted Reserved Commissioned Reserved Enlisted Retired OtherWhat is your occupation?: How long have you been with your occupation?: In the past 5 years have you filed for bankruptcy?: Yes NoIn the past 5 years have you had any repossessions, charge offs, or collections?: Yes NoHow would you describe your credit rating?: Poor Good ExcellentUnsure Driver #3 Name:Date of Birth:(mm/dd/yyyy) Gender:Male FemaleMarital Status: Single Married Divorced Separated WidowedResidence:Own Rent Live With Parents OtherRelationship to Driver#1: Social Security Number:(e.g. 555-55-5555) Drivers License Number: At what age did this driver first receive their license?: Has this driver been a U.S. or Canadian resident for the past 12 months?: Yes NoHas this driver completed Behind-the-Wheel in the last 5 years?: Yes NoIs this driver a full-time student with GPA of 3.0 or above?:Yes NoIn the past 5 years, has the driver's license been suspended or revoked?: Yes NoDoes the driver require an SR-22 or Financial Responsibility Statement?: Yes NoIn which state is this driver currently licensed?:AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WYWhat is the driver's highest education level?:Some or No High School High School Diploma G.E.D. Associates Degree Bachelors Degree Masters Degree Doctorate OtherPast or Present Military Experience?: No Military Experience Active Commissioned Active Enlisted Discharged Commissioned Discharged Enlisted Reserved Commissioned Reserved Enlisted Retired OtherWhat is your occupation?: How long have you been with your occupation?: In the past 5 years have you filed for bankruptcy?: Yes NoIn the past 5 years have you had any repossessions, charge offs, or collections?: Yes NoHow would you describe your credit rating?: Poor Good ExcellentUnsureIncident Information Driver #1 Incident 1:Date of Incident:(mm/yyyy) DUI Ticket Accident Claim  Incident 2:Date of Incident:(mm/yyyy) DUI Ticket Accident Claim  Incident 3:Date of Incident:(mm/yyyy) DUI Ticket Accident Claim  Incident 4:Date of Incident:(mm/yyyy) DUI Ticket Accident Claim  Driver #2Incident 1:Date of Incident:(mm/yyyy)DUI Ticket Accident Claim  Incident 2:Date of Incident:(mm/yyyy) DUI Ticket Accident Claim  Incident 3:Date of Incident:(mm/yyyy) DUI Ticket Accident Claim  Incident 4:Date of Incident:(mm/yyyy) DUI Ticket Accident Claim  Driver #3Incident 1:Date of Incident:(mm/yyyy)DUI Ticket Accident Claim  Incident 2:Date of Incident:(mm/yyyy) DUI Ticket Accident Claim  Incident 3:Date of Incident:(mm/yyyy) DUI Ticket Accident Claim  Incident 4:Date of Incident:(mm/yyyy) DUI Ticket Accident Claim  Vehicle Information Vehicle #1 * Year:* Make:* Model:* VIN #: * Zip Code where vehicle is garaged most: * Who is the primary driver of this vehicle?: * Is the vehicle primarily driven for commuting, business, or pleasure?:Commute Work Commute School Commute Varies Pleasure Business* If used for commuting or business - average number of days per week used?:(enter "0" if not applicable)* If vehicle is used for commuting - what is the average one-way mileage?:(enter "0" if not applicable)*Approximately how many miles is the vehicle driven in a year?:(average american drivers 12,000 per year) * Current Carrier:* Current Policy Expiration Date:(mm/dd/yyyy) Comprehensive and Collision deductible: Select the amount you are willing to pay in the event of a claim. The higher the deductible the lower the cost for the coverage. Finance companies require you carry this coverage if you are either purchasing or leasing a vehicle. * Comprehensive:No Deductible 100 200 250 500 1000 No Coverage * Collision:No Deductible 100 200 250 500 1000 No Coverage * Towing Labor: Yes No* Rental Reimbursement: Yes No* Is this vehicle leased?: Yes NoVehicle #2Year:Make:Model:VIN #: Zip Code where vehicle is garaged most: Who is the primary driver of this vehicle?: Is the vehicle primarily driven for commuting, business, or pleasure?:Commute Work Commute School Commute Varies Pleasure BusinessIf used for commuting or business - average number of days per week used?:(enter "0" if not applicable)If vehicle is used for commuting - what is the average one-way mileage?:(enter "0" if not applicable)Approximately how many miles is the vehicle driven in a year?:(average american drivers 12,000 per year) Current Carrier:Current Policy Expiration Date:(mm/dd/yyyy) Comprehensive and Collision deductible: Select the amount you are willing to pay in the event of a claim. The higher the deductible the lower the cost for the coverage. Finance companies require you carry this coverage if you are either purchasing or leasing a vehicle. Comprehensive:No Deductible 100 200 250 500 1000 No Coverage Collision:No Deductible 100 200 250 500 1000 No Coverage Towing Labor: Yes NoRental Reimbursement: Yes No Is this vehicle leased?: Yes NoVehicle #3Year:Make:Model:VIN #: Zip Code where vehicle is garaged most: Who is the primary driver of this vehicle?: Is the vehicle primarily driven for commuting, business, or pleasure?:Commute Work Commute School Commute Varies Pleasure BusinessIf used for commuting or business - average number of days per week used?:(enter "0" if not applicable)If vehicle is used for commuting - what is the average one-way mileage?:(enter "0" if not applicable)Approximately how many miles is the vehicle driven in a year?:(average american drivers 12,000 per year) Current Carrier:Current Policy Expiration Date:(mm/dd/yyyy) Comprehensive and Collision deductible: Select the amount you are willing to pay in the event of a claim. The higher the deductible the lower the cost for the coverage. Finance companies require you carry this coverage if you are either purchasing or leasing a vehicle. Comprehensive:No Deductible 100 200 250 500 1000 No Coverage Collision:No Deductible 100 200 250 500 1000 No Coverage Towing Labor: Yes NoRental Reimbursement: Yes NoIs this vehicle leased?: Yes No 
 

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