Hartland Insurance Group

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ESD Group Health

INDIVIDUAL HEALTH

Hartland Insurance Group is ready to help with your insurance needs.

If you are ready to fill out a questionnaire for Home or Auto insurance, please click the link below. You will be directed to a new page. Simply fill out the form online and click submit. It's that easy!

HOME INSURANCE QUESTIONNAIRE

AUTO INSURANCE QUESTIONNAIRE

If you would like to receive a quote from us please fill out the form below. We will be happy to contact you at your convenience.

Name
Address
City	State Zip
Phone	(including area code)
Email
	The best time to reach you
Questions or Notes to Agent
Questions or Notes to Agent

I am interested in the following coverages:

Homeowners	Condo
Tenants	Auto
Classic Auto	Umbrella Personal Excess Liability
Directors & Officers Insurance	Auto-Owners Individual Life
Commercial Property	Workers' Comp
Commercial Umbrella	Commercial General Liability
Employment Practices Liability	Employee Dishonesty
Bonds	Employee Benefits Liability
Employee Group Medical	Employee Group Dental
Employee Group Vision	Employee Group Long-Term Disability
Employee Group Short-Term Disability	Employee Group Long-Term Care
Employee Group Life Insurance and AD&D	Individual Short-Term Medical Insurance
Individual Life

Note: The above form is not an application for insurance. Once this form is completed and sent to us, you will be contacted by a member of our licensed, friendly, professional sales staff to discuss your specific insurance questions and needs. No coverage will be assumed bound or covered until written confirmation is received from Hartland Insurance Group.

HARTLAND INSURANCE GROUP, INC.
P.O. Box 215080
691 N. Squirrel Road, Suite 190
Auburn Hills, MI 48321-5080
(248) 377-9600 (800) 682-6881
Fax (248) 377-0082

info@hartlandinsurancegroup.com