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Michigan Community Insurance Agency
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Car Insurance - Short Form


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information
First Name
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Last Name
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Street
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City
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State
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ZIP / Postal Code
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Primary Phone Number
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Alternate Phone Number
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E-Mail Address
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Date of Birth
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Current Insurance Provider
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Current Policy End Date
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Do you rent or own your home?
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.


Coverage cannot be changed or bound by leaving a voice message,email or text.
Coverage cannot be bound without speaking directly with an agency representative.

 We are licensed to provide insurance products and service in the State of Michigan, and other states.
Copyright © 1999-2017 Michigan Community Insurance Agency®, Inc. and Michigan Community Benefits, LLC.

 


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