Toll Free: 866-297-5213 • Main Office: 715-335-4549 • Saratoga: 715-325-3030 • Plainfield: 715-335-4275 • Withe 715-785-7729

Established 2002

Main Office
5495 Country Road West
Bancroft, WI 54921

Saratoga Office
9031 Highway 13 South
Wisconsin Rapids, WI 54494

Plainfield Office
121 West North Street
Plainfield, WI 54966
customerservice@hometownins.biz

Withe Office
N. 2570 Winter Sports Road
Withe, WI 54498

 

Request a Quote

We would appreciate it if you would take a few moments to answer the following questions. Please be assured that we do not share or sell personal information about you, except when we have your permission.
First Name
M.I.
Last Name
Address Line 1
Address Line 2
City
State
ZIP Code
Bold = Required field
Person to Be Insured
Date of Birth
Gender
Marital Status
Height
Weight
Has this person used any tobacco products in the past 12 months?
Is this person an expectant mother or father?
Select any of the following that the person to be quoted has been diagnosed with (in the past 10 years):
If you've selected any of the above, please provide date of onset, diagnosis and current status:
Does this person take any medications?
If you answered yes to medications, please list medication name and dosage:
Does this person have any immediate relatives who have ever had heart disease?
Does this person have any immediate relatives who have had any form of cancer?
Has this person been a U.S. or Canadian resident for at least 12 months?
What is this person's highest education level?
Past or present military experience
What is this person's occupation?
Is this individual a private pilot or student pilot?
Does this person engage in scuba diving, sky diving, rock climbing, motorized racing or any other hazardous avocation or occupation?
Has this person been convicted of drunken driving in the past 7 years?
Has this person's driver's license been suspended or revoked in the past 7 years?
Has this person been convicted of 2 or more moving violations in the past 3 years?
Has this person ever been convicted of, or is now awaiting trial for, a felony?
In the past 5 years, has this person filed for bankruptcy?
If you answered yes to any of the above 7 questions, please provide any further information you feel would help explain your answer:
E-mail Address
Phone Number
ZIP Code
State
City
Address
Last Name
First Name
Contact Information

Life Insurance Quote

Health and Dental Insurance Quote

We would appreciate it if you would take a few moments to answer the following questions. Please be assured that we do not share or sell personal information about you, except when we have your permission.
First Name
M.I.
Last Name
Address Line 1
Address Line 2
City
State
ZIP Code
Bold = Required field
Person to Be Insured
Date of Birth
Gender
Marital Status
Height
Weight
Has this person used any tobacco products in the past 12 months?
Is this person an expectant mother or father?
Select any of the following that the person to be quoted has been diagnosed with (in the past 10 years):
If you've selected any of the above, please provide date of onset, diagnosis and current status:
Does this person take any medications?
If you answered yes to medications, please list medication name and dosage:
Does this person have any immediate relatives who have ever had heart disease?
Does this person have any immediate relatives who have had any form of cancer?
Has this person been a U.S. or Canadian resident for at least 12 months?
What is this person's highest education level?
Past or present military experience
What is this person's occupation?
Do you need to add another person to be quoted (including children)?
Requested Policy Coverages
Medical Plans (select at least one)
(MMP) Major Medical Plan — This plan is favored by those who prefer to choose any doctor or hospital. This is typically the most expensive medical program.
(PPO) Preferred Provider Organization — This plan generally affords you the ability to choose any doctor or hospital from the PPO's directory or to use a doctor outside the plan, at a higher expense.
(POS) Point of Service — This plan typically has a network, but allows for self and physician referrals to be covered regardless of network status.
Optional Coverage / Benefits — (Select any that you are interested in)
Dental Coverage
Maternity Coverage
Prescription Benefit
Vision Care Benefit
E-mail Address
Phone Number
ZIP Code
State
City
Address
Last Name
First Name
Contact Information

Auto Insurance Quote

Please complete the following form and click Submit. We will contact you as soon as possible regarding your request.
Last Name
Address Line 2
City
State
ZIP Code
E-mail Address
Bold = Required field
Contact Information
First Name
Address Line 1
Marital Status
Gender
Age
State Licensed
Homeowner
Current Policy Information
Current Insurance Carrier (Not Agency)
Expiration Date
Length of Time Continuously Insured
Second Driver Information
Name
Gender
Age
Marital Status
State Licensed
Vehicle 1 Information
Vehicle 1 Year
Make
Model
Requested Coverage
Bodily Injury
Property Damage
Uninsured/Under Insured Motorist
Comprehesive Deductible
Collision Deductible
Full Glass?
Towing?
Rental?
Vehicle 2 Information
Vehicle 2 Year
Make
Model
Requested Coverage
Bodily Injury
Property Damage
Uninsured/Under Insured Motorist
Comprehensive Deductible
Collision Deductible
Full Glass?
Towing?
Rental?
Please give additional comments about coverage you desire. For additional drivers, please enter name, date of birth, state licensed and relation to you. For additional vehicles, enter year, make, model and VIN.
Additional Comments
Please complete the following form and click Submit. We will contact you as soon as possible regarding your request.
Last Name
Address Line 2
City
State
ZIP Code
E-mail Address
Bold = Required field
Contact Information
First Name
Address Line 1
Marital Status
Gender
Age
State Licensed
Homeowner
Current Policy Information
Current Insurance Carrier (Not Agency)
Expiration Date
Length of Time Continuously Insured
Second Driver Information
Name
Gender
Age
Marital Status
State Licensed
Vehicle 1 Information
Vehicle 1 Year
Make
Model
Requested Coverage
Bodily Injury
Property Damage
Uninsured/Under Insured Motorist
Comprehesive Deductible
Collision Deductible
Full Glass?
Towing?
Rental?
Vehicle 2 Information
Vehicle 2 Year
Make
Model
Requested Coverage
Bodily Injury
Property Damage
Uninsured/Under Insured Motorist
Comprehensive Deductible
Collision Deductible
Full Glass?
Towing?
Rental?
Please give additional comments about coverage you desire. For additional drivers, please enter name, date of birth, state licensed and relation to you. For additional vehicles, enter year, make, model and VIN.
Additional Comments

Recreational Vehicle Insurance Quote

Please complete the following form and click Submit. We will contact you as soon as possible regarding your request.
Last Name
Address Line 2
City
State
ZIP Code
E-mail Address
Bold = Required field
Contact Information
First Name
Address Line 1
Marital Status
Gender
Age
State Licensed
Homeowner
Current Policy Information
Current Insurance Carrier (Not Agency)
Expiration Date
Length of Time Continuously Insured
Second Driver Information
Name
Gender
Age
Marital Status
State Licensed
Vehicle 1 Information
Vehicle 1 Year
Make
Model
Requested Coverage
Bodily Injury
Property Damage
Uninsured/Under Insured Motorist
Comprehesive Deductible
Collision Deductible
Full Glass?
Towing?
Rental?
Vehicle 2 Information
Vehicle 2 Year
Make
Model
Requested Coverage
Bodily Injury
Property Damage
Uninsured/Under Insured Motorist
Comprehensive Deductible
Collision Deductible
Full Glass?
Towing?
Rental?
Please give additional comments about coverage you desire. For additional drivers, please enter name, date of birth, state licensed and relation to you. For additional vehicles, enter year, make, model and VIN.
Additional Comments

Motorcycle Insurance Quote

We would appreciate it if you would take a few moments to answer the following questions. Please be assured that we do not share or sell personal information about you except when we have your permission.
First Name
M.I.
Last Name
Address Line 1
Address Line 2
City
State
Zip Code
Country
E-mail Address
Phone
Alternate Phone
Fax
Bold = Required field
Address of property to be insured
If currently insured then who is carrier?
Residence Type:   Please Select
Select a date
When does the coverage need to be effective?
Purchase Price or Estimated Replacement Cost of Dwelling: $
Is there a swimming pool at the home?
Yes
No
No
Yes
Does the home have an alarm system?
Is there any other information about your insurance request, that you believe would assist us in providing you an accurate and competitive quote. ( Examples: Mortgage Broker's name and phone number or any other underwriting information such as pet types and breeds ).

Home Insurance Quote

Thank you for the opportunity to provide you a quote for insurance.

All quotes are conditional, based upon the underwriting guidelines of each company represented by our agency. Additionally, we cannot alter or bind coverage via this website. Once again, thank you.

One of our licensed representatives will be in touch with you within the next business day to expedite providing your quote.

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