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Members Insurance Agency
 

Members Insurance Agency was established March 2005 as an additional service to our credit union members. As an independent Oklahoma agent, we want to help you find the best insurance for your specific needs at a rate you can afford. Our main goal is to offer friendly and professional insurance advice in a convenient location.

 
 
Tulsa Federal CU | MIA Quick Quote Request a free, no-obligation quote today!
First Name: Required.
Last Name: Required
Driver's Licence #:
Spouse's First Name:
(If applicable)
Spouse's Last Name:
(If applicable)
Spouse's Driver's Licence #:
Current Address*:
 Required
  Required
  RequiredInvalid
E-mail: RequiredInvalid
Home Ownership:
Home Phone Number: Invalid (000) 000-0000
Work Phone Number: Invalid (000) 000-0000
Current Insurance Carrier:
Enforced at least 6 months?
 
Vehicle Information
Vehicle  Year  Make  Model
#1
#2
#3
#4
 
Mileage Information
Vehicle   Usage Commute?  Annual Miles Ownership   Current Odometer
#1

(one way)
#2

(one way)
#3

(one way)
#4

(one way)
 
Coverage Amounts
Type Vehicle #1 Vehicle #2 Vehicle #3 Vehicle #4
Bodily Injury/ Property Damage Liability
Medical
Uninsured Motorist Limits
Uninsured Motorist Limits
Uninsured Motorist Limits
Comprehensive Deductible
Collision Deductible
Towing
Rental
 
Resident & Driver Information (List all residents & dependents, licensed or not)
# Name on DL Gender Martial Status Relation Date of Birth
MM/DD/YYYY		 DL # State
#1
#2
#3
#4
#5
 
Accidents / Convictions (Driving records will be verified with the motor vehicles depart.)
Driver #1
Driver #2
Driver #3
Driver #4
 
 
 
 
For more information contact Sue Riley
 
Email: sriley@rcins.com
Phone: (918)270-6790
Fax: (918)744-8429
9323 E 21st St., Suite 101, Tulsa, OK.
Orange Text Denotes required information.
 
*Currently available for Oklahoma residents only.

Consumer reports, including credit and insurance loss history reports, may be ordered in conjunction with this application. We may also obtain and use a credit-based insurance score developed from information contained in these reports. We may use a third party in connection with the development of your insurance score. These reports provide information that assists with determining your eligibility for insurance and the price you are charged.

 
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