Keltner Insurance Inc
Your Local Independent Insurance Agency
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For Help Call 901-797-8665
Fields marked (
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) are mandatory.
V IN (If available, please enter the unit's VIN)
Year
*
Make
*
Model
*
Gross Vehicle Weight
*
Under 26,500 lb.
Over 26,500 lb.
Garaging Zip Code
*
What is the maximum radius of this vehicle?
0-25 Miles
26-50 Miles
51-70 Miles
76-100 Miles
101-150 Miles
151-200 Miles
201-300 Miles
301-500 Miles
Over 500 miles (Unlimited)
Physical Damage for this unit
Yes
No
If Yes
a. Stated Value $
b. Comprehensive/ Collision Deductibles.
$250/$250
$500/$500
$1,000/$1,000
$2,500/$2,500
$5,000/$5,000
$10,000/$10,000