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AUTO & HOME COVERAGE

Please complete the information below. Submissions will be sent to and a member of the Preferred Insurance Group team will be in touch with you ASAP.

Preferred Insurance Group
Wix: Auto & Home Quote

Referred By

First Name

Last Name

Date of Birth

Gender

Marital Status

Street Address

City

Region/State/Province

Postal / Zip code

Email

Phone

Properties Owned or Rented

Age of Roof

Number of Vehicles in Household

Current Insurance Carrier

How long have you been with this carrier?

Tickets/Accidents (in the past 3 years)

Tickets/Accidents (in the past 5 years)

By submitting this form, you authorize a representative from Preferred Insurance Group or one of their affiliate partners to reach out to you for a quote

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Questions?

Contact Mark Kleiner

(502) 813-2112 or mark@preferredinsgroup.com.

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