Mikkelsen Insurance ervices
Information needed for Adult Sports League (Non-Professional) Accident and Liability Insurance quote (California Only)! Please complete all blanks. ( Privacy Statement )

Name:
League name:
Address:
City: CA
Zip code:
Phone:
Sport coverage available, please select from menu:
Number of teams: Total number of players:
Limits - Medical Expenses/AD & D:

(Limit availability and deductibles will vary with sport selected)

Deductible:
Liability Limit: (Accident policy with at lest $10,000 benefit required.)
Hired & Non-owned Auto Liability Yes/No?
Additional information:
E-mail address:

Be sure all questions are answered. We are unable to respond to requests with incomplete information.

For a FREE quote please complete the form and press "Send" or if you prefer you may print it and Fax it to us at: 209-839-8632

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