Policy Holder: (Items marked * are required)
Current Insurance Information
Claims - List any claims in past 3 years.
Personal Property - Estimated value of your personal property:
Please enter the exact text shown next to the box below.
Numbers and lower case letters only
* This must be filled in for your message to be sent. Thank you.
You will receive a confirmation that your message was sent.
If you do not receive the confirmation e-mail your address may have been entered
Keuler Insurance Agency, Inc.
222 High St.
Mineral Point, WI 53565
Toll Free: 888-987-2021