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Please simply enter your information in the form below. The information will be kept secure and sent to an agent at C&E Insurance and Financial Services. We will process your quotes in a timely manner and help you protect what is important to you. Don't forget to click "submit" and send your information to one of our trusted agents. Thank You!


Personal Information
First Name
Required
Last Name
Required
Street Address
Required
City
Required
State
Required
ZIP / Postal Code
Required
Primary Phone Number
Required
Alternate Phone Number
Optional
E-Mail Address
Required
Date of Birth
Required
Marital Status
Required
Gender
Required
Do You rent or own your home/condo?
Optional
Do you currently have insurance?
Optional
Current Insurance Provider
Optional
If no, when did you last have insurance?
Optional
/ /
How did you hear about us?
Optional
Driver Information
Driver 1 Name (First, Last)
Required
Vehicle Used
Required


Relationship
Optional
Gender
Required
Marital Status
Required
Date of Birth
Required
/ /
Percent Used
Optional
License Number
Required
License State
Required
Education Level
Optional
Vehicle Information
Vehicle 1 Year Model
Required
Vehicle 1 Make
Required
Vehicle 1 Model
Required
Vehicle 1 VIN
Optional
Annual Miles Vehicle 1
Optional
Drive vehicle 1 to school or work?
Optional
Vehicle 1 - Average Commute in Miles
Optional
Vehicle 1 - How many days per week do you commute?
Optional
Vehicle 1 - Comprehensive Deductible
Optional
Vehicle 1 - Collision Deductible
Optional
Vehicle 1 - Towing
Optional
Vehicle 1- Rental
Optional
Coverage Options
Bodily Injury Liability
Required
Property Damage Liability
Required
Underinsured Motorist - Bodily Injury Limits
Optional
Underinsured Motorist - Property Damage Limits
Optional
Driver Two Information
Driver Two Name (First, Last)
Optional
Vehicle #2
Optional


Relationship
Optional
Gender
Optional
Marital Status
Optional
Date of Birth
Optional
Percent Used
Optional
License Number
Optional
License State
Optional
Education Level
Optional
Vehicle Two Information
Vehicle 2 Year
Optional
Vehicle 2 Make
Optional
Vehicle 2 Model
Optional
Vehicle 2 VIN
Optional
Annual Miles Vehicle 2
Optional
Drive vehicle 2 to school or work?
Optional
Vehicle 2 - Average Commute in Miles
Optional
Vehicle 2 - How many days per week do you commute?
Optional
Vehicle 2 - Comprehensive Deductible
Optional
Vehicle 2 - Collision Deductible
Optional
Vehicle 2 - Towing
Optional
Vehicle 2- Rental
Optional
Vehicle Three Information
Vehicle 3 Year
Optional
Vehicle 3 Make
Optional
Vehicle 3 Model
Optional
Vehicle 3 VIN
Optional
Annual Miles Vehicle 3
Optional
Drive vehicle 3 to school or work?
Optional
Vehicle 3 - Average Commute in Miles
Optional
Vehicle 3 - How many days per week do you commute?
Optional
Vehicle 3 - Comprehensive Deductible
Optional
Vehicle 3 - Collision Deductible
Optional
Vehicle 3 - Towing
Optional
Vehicle 3- Rental
Optional
Submission Validation
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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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Baltimore, MD 21222
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