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800-697-1656
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Exchange Insurance Agency Inc.
718 Central, PO Box 218
St. Paul, Kansas 66771
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Altamont Office
Phone: 620-449-2202
Fax: 620-449-2205
Toll Free: 800-697-1656
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ONLINE QUOTE FORM
Crop Insurance Quote Form
First & Last Name:
Street Address:
City, State & Zip:
E-Mail Address:
Telephone:
Fax:
County:
Crop (s):
What type of coverage are you interested in?:
Select..
Yield Based
Crop Hail
Crop Revenue Coverage
Catastrophic Coverage
Revenue Assurance
Please Indicate Production
Crop
Acres
Yield
Irrigated?
Yes
No
Yes
No
Yes
No
Yes
No
How did you hear about us?
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Additional Information / comments that will assist us in your crop insurance quote:
Note: By submitting this form you understand that no coverage is bound until you receive written notice. You also agree to release us from any liability if this information is accidentally viewed by unauthorized persons. We will only use this information for insurance quoting purposes and not distribute to other parties.
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