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POST //www.weebly.com/weebly/apps/formSubmitAjax.php

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          <label class="wsite-form-label" for="input-124621949312710037">Where are you travelling? <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
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          <div id="instructions-124621949312710037" class="wsite-form-instructions" style="display:none;">Please enter the specific location(s) you are traveling to.</div>
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                      <div class="wsite-form-field" style="margin:5px 0px 5px 0px;">
                        <label class="wsite-form-label" for="input-330904132699538477">Date of Departure <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
                        <div class="wsite-form-input-container">
                          <input aria-required="true" id="input-330904132699538477" class="wsite-form-input wsite-input wsite-input-width-370px" type="text" name="_u330904132699538477">
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                        <div id="instructions-330904132699538477" class="wsite-form-instructions" style="display:none;">Enter the date you are planning to leave on your trip.</div>
                      </div>
                    </div>
                  </td>
                  <td class="wsite-multicol-col" style="width:50%; padding:0 15px;">
                    <div>
                      <div class="wsite-form-field" style="margin:5px 0px 5px 0px;">
                        <label class="wsite-form-label" for="input-866049609790613061">Date of Return <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
                        <div class="wsite-form-input-container">
                          <input aria-required="true" id="input-866049609790613061" class="wsite-form-input wsite-input wsite-input-width-370px" type="text" name="_u866049609790613061">
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                        <div id="instructions-866049609790613061" class="wsite-form-instructions" style="display:none;">Please enter the date you are planning to return home from your travel.</div>
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                    </div>
                  </td>
                </tr>
              </tbody>
            </table>
          </div>
        </div>
      </div>
      <div>
        <div class="wsite-form-field wsite-name-field" style="margin:5px 0px 5px 0px;">
          <label class="wsite-form-label">Name <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
          <div style="clear:both;"></div>
          <div class="wsite-form-input-container wsite-form-left wsite-form-input-first-name">
            <input aria-required="true" id="input-705171062211508177" class="wsite-form-input wsite-input" placeholder="First" type="text" name="_u705171062211508177[first]">
            <label class="wsite-form-sublabel" for="input-705171062211508177">First</label>
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          <div class="wsite-form-input-container wsite-form-right wsite-form-input-last-name">
            <input aria-required="true" id="input-705171062211508177-1" class="wsite-form-input wsite-input" placeholder="Last" type="text" name="_u705171062211508177[last]">
            <label class="wsite-form-sublabel" for="input-705171062211508177-1">Last</label>
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          <div id="instructions-705171062211508177" class="wsite-form-instructions" style="display:none;">Please enter your name.</div>
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        <div style="clear:both;"></div>
      </div>
      <div>
        <div class="wsite-form-field" style="margin:5px 0px 5px 0px;">
          <label class="wsite-form-label" for="input-407893585581617868">Email <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
          <div class="wsite-form-input-container">
            <input aria-required="true" id="input-407893585581617868" class="wsite-form-input wsite-input wsite-input-width-370px" type="text" name="_u407893585581617868">
          </div>
          <div id="instructions-407893585581617868" class="wsite-form-instructions" style="display:none;">Please enter an email address where we can contact you about this travel insurance quote.</div>
        </div>
      </div>
      <div>
        <div class="wsite-form-field wsite-phone-field" style="margin-top:5px;">
          <label class="wsite-form-label" for="input-518047336636219404">Phone Number <span class="form-not-required">*</span><span class="wsite-instructions-help"></span></label>
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          </div>
          <div id="instructions-518047336636219404" class="wsite-form-instructions" style="display:none;">Please enter a phone number where we can contact you about this travel insurance quote.</div>
        </div>
        <div style="clear:both;"></div>
      </div>
      <div>
        <div class="wsite-form-field" style="margin:5px 0px 5px 0px;">
          <label class="wsite-form-label" for="input-876486684195036910">Comment <span class="form-not-required">*</span><span class="wsite-instructions-help"></span></label>
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          </div>
          <div id="instructions-876486684195036910" class="wsite-form-instructions" style="display:none;">Please provide any other additional information you think we may need to provide your travel insurance quote.</div>
        </div>
      </div>
      <div>
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          <div class="wsite-form-field" style="margin:10px 0 0 0;">
            <label class="wsite-form-label">🔒 Your information is secure.<span class="wsite-instructions-help"></span></label>
            <div class="wsite-form-instructions" style="display:none;">Your private information is provided exclusively to our agency and will not be redistributed or sold to anyone else.</div>
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				<span class="wsite-button-inner">Get QUOTE</span>
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* Indicates required field
Where are you travelling? *

Please enter the specific location(s) you are traveling to.
Date of Departure *

Enter the date you are planning to leave on your trip.
Date of Return *

Please enter the date you are planning to return home from your travel.

Name *

First
Last
Please enter your name.

Email *

Please enter an email address where we can contact you about this travel
insurance quote.
Phone Number *


Please enter a phone number where we can contact you about this travel insurance
quote.

Comment *

Please provide any other additional information you think we may need to provide
your travel insurance quote.
🔒 Your information is secure.
Your private information is provided exclusively to our agency and will not be
redistributed or sold to anyone else.


Get QUOTE

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Miner Family Insurance
3209 S Broadway
Suite 229
Edmond, OK 73013
(405) 724-2389
Click Here to Email Us


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Homepage banner credit: Greater Oklahoma City by  Lillie-Beth Brinkman
lbrinkman@okcchamber.com (CC BY-SA 3.0)
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Please ensure Javascript is enabled for purposes of website accessibility
Please enter the specific location(s) you are traveling to.
Enter the date you are planning to leave on your trip.
Please enter the date you are planning to return home from your travel.
Please enter your name.
Please enter an email address where we can contact you about this travel
insurance quote.
Please enter a phone number where we can contact you about this travel insurance
quote.
Please provide any other additional information you think we may need to provide
your travel insurance quote.
Your private information is provided exclusively to our agency and will not be
redistributed or sold to anyone else.
 * Auto Quotes >
    * Auto Insurance Quote
    * Motorcycle Quote
    * RV Insurance Quote
    * Classic Car Insurance Quote
    * ATV Insurance Quote

 * Property Quotes >
    * Home Insurance Quote
    * Landlords Insurance Quote
    * Renters Insurance Quote
    * Earthquake Insurance Quote
    * Flood Insurance Quote

 * Life & Financial Quotes >
    * Life Insurance Quote
    * Final Expense Insurance Quote

 * Business Quotes >
    * Business Insurance Quote
    * Workers Compensation Quote
    * Business Owners Package (BOP) Insurance Quote

 * Health Insurance Quote
 * Other Quotes >
    * Boat Insurance Quote
    * Event Insurance Quote
    * Umbrella Insurance Quote
    * Travel Insurance Quote
    * Wedding Insurance Quote

 * Vehicles >
    * Auto Insurance
    * ATV Insurance
    * Classic Car Insurance
    * Motorcycle Insurance
    * RV Insurance

 * Property >
    * Home Insurance
    * Earthquake Insurance
    * Flood Insurance
    * Landlords Insurance
    * Renters Insurance

 * Life/Financial >
    * Life Insurance
    * Final Expense Insurance

 * Business >
    * Business Insurance
    * Business Owners Package (BOP) Insurance
    * Insurance Bonds
    * Workers Compensation

 * Other >
    * Boat Insurance
    * Event Insurance
    * Travel Insurance
    * Wedding Insurance
    * Umbrella Insurance

 * Client Testimonials
 * Refer a Friend
 * Insurance Carriers
 * Book An Appointment
 * Accessibility Statement