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    Primary Applicant

    Primary Applicant Name

    Date of Birth?


    Are you a Smoker?


    Phone Number

    Your Email (required)


    Please use this space to supply us with additional information, or policy requirements and specifications that you may have.

    Secondary Applicant

    Spouse Name

    Spouse Date of Birth?

    Is your Spouse Male/Female?

    Is your Spouse a Smoker?


    Dependent 1 Name

    Dependent 1 Date of Birth?

    Is your Dependent 1 Male/Female?

    Is your Dependent 1 a Smoker?

    Dependent 2 Name

    Dependent 2 Date of Birth?

    Is your Dependent 2 Male/Female?

    Is your Dependent 2 a Smoker?

    R.A.K. Agency, Inc. wants to make insurance shopping as easy as possible. Begin the process by submitting your information through this website, and our agents will get to work.

    Individual Insurance

    Whether you need an annual policy or short term coverage, our individual policies will have you covered.

    Family Insurance

    We care about everyone, and know the importance of insurance coverage for the entire family.

    Group & Business Insurance

    Business Owners can count on us to develop cost effective employee benefits packages.

    Please note completion of any request(s) for information does not constitute the purchase of insurance. R.A.K. Agency, Inc. respects the privacy of our clients and the users of our website and services. All information collected is for potential business purposes and communication only. We will never disclose or solicit your information to a third party.

    We don’t sell policies. We find the best ones for you.

    Navigating through the health insurance marketplace is challenging. Having an expert to help you navigate the varied and rapidly changing options to find the right competitively priced health coverage can save you time, money and aggravation. Our services and expertise are at no cost to you.

    Contact Info

    (630) 443-8100

    (630) 443-8030

    Richard Kaufmann

    Kurt Kaufmann


    6N343 E. Ridgewood Dr. St. Charles, IL 60175


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