MDA Insurance offers incredible rates and group savings on auto, home and personal umbrella insurance. We also insure boats, motorcycles, vacation homes and other recreational assets. Request your auto / home quick quote today and receive a $10 gift card!

Personal Information

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Home Information:

Auto / Motorcycle / ATV Information:

Vehicle 1

Vehicle 2

Vehicle 3




Vehicle ID VIN:

Principal Driver's Name:

Driver's date of birth:

Driver’s license #:

Number of miles to work:

Comp Coverage Deductible:

Collision Coverage Deductible:

Bodily Injury / Property Damage amt:

Uninsured / underinsured:

Tickets/accidents in last 3 years?

Towing Coverage?

Rental Reimbursement?

Questions? Call MDA Insurance at 800.860.2272.
MDA Insurance | 3657 Okemos Road, Suite 100 | Okemos, MI 48864
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This is not an offer to sell insurance. Insurance coverage cannot be bound or changed via submission of this online form. Note that any proposal of insurance we may present to you will be based upon the values developed and exposures to loss disclosed to us on this online form and/or in communications with us. All coverage is subject to the terms, conditions and exclusions of the actual policy issued.