If you are located in in Maine, Massachusetts, New Hampshire or Vermont  please fill in the form below.  

You can also click here to print the form if you prefer to mail it to: Morton & Furbish Insurance Agency, P.O. Box 130, Rangeley, ME 04970 or fax it to (207) 864-2008.

If you are from any other state please call
1-888-346-4673 and when prompted for recruiter give 3490A for a quote. 

State in which you are located:  Select One Maine Massachussets New Hampshire Vermont

Please provide the following contact information:

Name
Date of Birth
Street Address
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