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General Information

Tell Us About Yourself

Sex:  Male Female

Marital Status:  Single Married

Coverage Information

Common Life Insurance Policies:
 Term Whole Life Variable Life Universal Life Unsure

Medical History

The applicant has been denied health coverage in the past 12 months.

The applicant is pregnant or has reason to believe that she is.

The applicant has been treated by a physician in the past 12 months (excluding voluntary annual check ups, pap smears, minor colds and flu, etc).

The applicant has been hospitalized in the past 5 years (excluding pregnancy).

The applicant has been receiving ongoing medical treatments (excluding regular pap smears, voluntary check-ups, etc).

The applicant smokes or uses other form of tobacco.




Heart Attack

High Blood Pressure



Depression Requiring Medication

Other Major Illness

A Few More Questions

Current work status:
 Employed Government Military Retired Homemaker Student

Are you self-employed:  Yes No

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Product Overview

Wisconsin-Michigan Insurance Agency specializes in personal and commercial insurance protection. We meet the needs of our customers for solid, reliable insurance plans for their autos, homes, recreational vehicles, farms and businesses.

Wisconsin-Michigan Insurance Agency also provides health, life, medical supplements and disability income policies.

Wisconsin-Michigan Insurance Agency also sells insurance policies with discounts for specific group members such as Wisconsin Educators, AARP, Chamber of Commerce, Allumni Group, and Bank & Credit Union Members. Also ask us about worker’s compensation insurance policies that offer dividend programs.

Policies for immediate SR-22 high risk auto can be issued in our office with several different insurance companies

Product-Specific Business Owner Policies Available

  • Appliance Stores
  • Automobile Repair Shops
  • Automobile Sales Garages
  • Bakeries
  • Beauty Shops
  • Churches
  • Contractors (All Types)
  • Convenience Stores
  • Florists
  • Floor Covering Stores
  • Grocery Stores
  • Hardware Stores
  • Offices (All Types)
How to get the best value for your insurance dollar

How to get the best value for your insurance dollar

Buying insurance can be confusing. Price is important, but so is getting the right coverage for your needs. You want and need top value in your coverage – whether it’s for your home, your car, your family or your business.

The Value of Value
Sure, the price of insurance is important. But never shop on the basis of price alone. Real value means more. You want insurance that provides the right kind of protection for your needs. You want an insurance company that’s loyal and pays valid claims promptly. You also want an agent who provides courteous service, someone who goes to bat for you when you need help or advice.

Emergency Contact: (715) 923-4873