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Life Quote Form


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

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Tobacco Used?
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I understand that coverage cannot be bound or altered by this submission request until the information has been specifically confirmed by a Liebler Agency representative by phone or email.
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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Marlette Office
3521 VanDyke Road, Suite B
Marlette, MI 48453
PH: 989-635-6800 or
888-455-9922
North Branch
3789 Huron Street
North Branch, MI 48461
PH: 810-688-3077 or
888-689-9915
Brown City
4232 Main Street
Brown City, MI 48416
PH: 810-346-2738 or
800-242-5645
Yale
100 S. Main Street
Yale, MI 48097
PH: 810-387-4214 or
800-530-7499
Imlay City
172 N Cedar Street
Imlay City, MI 48444
PH: 810-724-8600 or
866-724-8979
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