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All Rights Reserved.
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Securities and advisory services offered through Commonwealth Financial Network®, Member www.FINRA.org/www.SIPC.org, a Registered Investment Adviser. Fixed insurance products and services offered through Pipes Insurance Service, LTD, MaPP Investment Service, LLC or CES Insurance Agency.

This communication is strictly intended for individuals residing in the states of AL, CA, GA, FL, MI, NC, SC, IL, PA, TX, WV and OH. No offers may be made or accepted from any resident outside these states due to various state regulations and registration requirements regarding investment products and services.

You’ve worked hard and want to protect what’s important…

Insurance is more than a product. It’s a relationship with people who understand how important you are, and how hard you’ve worked to get where you are today.

At Pipes Insurance Service, you are not a policy number or a product. You are a valued neighbor and we will work hard to protect what’s important to you.

 Request a Quote  Watch PiPES Insurance Service video

Coverage via this online request is NOT bound until you have received an acknowledgement from our office.

Please click on the link below to achnowledge that you have read and understand the above statement.

I understand and agree with the above statement.

I wish to proceed with my quote request. I prefer to speak with an agency representative.

Please take me to a contact page instead.
Please note: We cannot bind coverage from an email or voicemail request Coverage is bound after you receive a written email or telephone confirmation from an agency staff member.
Type of Policy:
Policy Number:
Your Name:
Contact Information:
Home Phone:
Work Phone:
E-Mail:
Best time to call:
 
Date of change:
Description of change:
 
Comments/other information:
It is our policy to make every effort to respond to this request within one business day.  Thank you. 
Coverage via this online request is NOT bound until you have received an acknowledgement from our office.

Please click on the link below to achnowledge that you have read and understand the above statement.

I understand and agree with the above statement.

I wish to proceed with my quote request. I prefer to speak with an agency representative.

Please take me to a contact page instead.
If you are interested in an insurance quote, please send us your name and contact information. Someone from our office will contact you to obtain the necessary information. Our Agency is dedicated to our customers and we do not sell or distribute your information to any third party.  Please note: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member.
 
Name:
Email:
Daytime Phone:
Evening Phone:
Type of Insurance: Personal     Commercial   Other (Describe below)
Please provide a description/details about the type of quote you are looking for.
We will contact you ASAP to gather the information required to provide you with a quote.
It is our policy to make every effort to respond to this request within one business day. Thank you.
Coverage via this online request is NOT bound until you have received an acknowledgement from our office.

Please click on the link below to achnowledge that you have read and understand the above statement.

I understand and agree with the above statement.

I wish to proceed with my quote request. I prefer to speak with an agency representative.

Please take me to a contact page instead.
Please note: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member.
Effective Date:
Policy Number:  
Your Name:  
E-mail:  
Daytime Phone#:  
Choose One:
 
Delete Vehicle: Year 
VIN
Make/Model
Reason:
Add Vehicle: Year
 VIN
 Make/Model
Owner:  
Primary Driver:  
Describe Use:
 
Coverage Requested:
Additional Coverage:
(Please use Other Comments area below for any desired coverage not listed here.) 		Towing: 

Rental Reimbursement:  

Loan/Lease Gap:   
  Anti-lock Brakes: 
  Anti-Theft Alarm: 
  Airbags: 
 
Additional Interest, if any:
 
New Name:  
Street Address:  
City/State/Zip:  
 
Comments:
It is our policy to make every effort to respond to this request within one business day. Thank you.
Name:
Email:
Message:

Call us at: 330-339-6413 or 888-328-8958

Coverage via this online request is NOT bound until you have received an acknowledgement from our office.

Please click on the link below to achnowledge that you have read and understand the above statement.

I understand and agree with the above statement.

I wish to proceed with my quote request. I prefer to speak with an agency representative.

Please take me to a contact page instead.

Business/Commercial Insurance Quote Request
Please note: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member.
Your name: No of employees:
Email: Annual sales:
Phone: Payroll:
Business name: No. of owners/officers:
Address: Street

City, State, Zip
 Type of business:
Years in business:
Current Carrier:
Current Effective date:
Describe your business:
 
Property Coverage:
If property coverage is needed, please complete this section.  If property coverage is not needed, please skip to Liability section.
Building Limit: Contents Limit:
Construction Type: Year Built:
Square Footage: Roof Type:
 
Liability Coverage:
Liability Limit:    
 
Business Auto Coverage:
If auto coverage needed, please complete this section.  If auto coverage is not needed, please skip to Comments section.
Liability Limit:
Any drivers under 25 or over 70?
Covered vehicles:
Veh Year Make/Model Gross Weight Radius Driven Comp Coverage Collision Coverage
1
2
3
4
5
Do any vehicles listed above have special equipment?  If yes, please describe below:
 
Comments:
Please include any additional information or comments here:
Protecting your privacy and identity is very important to us.
Social Security and drivers license numbers may be required to complete this quote. Please be sure you have provided an accurate contact number so that we can contact you personally for this information.
It is our policy to make every effort to respond to this request within one business day. Thank You.
Your Name:
Email:
Question:

Call us at: 330-339-6413 or 888-328-8958

Contact a Company
AultCare 1-800-344-8858
Anthem Please refer to the phone number on the back of your ID card or call our office at 330-339-6413
Medical Mutual 1-800-272-6967
Coverage via this online request is NOT bound until you have received an acknowledgement from our office.

Please click on the link below to achnowledge that you have read and understand the above statement.

I understand and agree with the above statement.

I wish to proceed with my quote request. I prefer to speak with an agency representative.

Please take me to a contact page instead.
Please note: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member.

Name of your group:
Address of group:
Name and phone number of contact:
Nature of Business:
Federal Tax ID:
Number of full time employees(25+avg hrs/wk):
Type of Insurance you're interested in:
It is our policy to make every effort to respond to this request within one business day. Thank you.

Health
AultCare 1-800-344-8858
Medical Mutual 1-800-523-8558
Anthem 1-888-224-4902

LIFE
Grange Life 1-800-399-3797
Cincinnati Life 1-888-242-8811
Ohio National 1-800-366-6654
Mass Mutual 1-800-272-2216
Coverage via this online request is NOT bound until you have received an acknowledgement from our office.

Please click on the link below to achnowledge that you have read and understand the above statement.

I understand and agree with the above statement.

I wish to proceed with my quote request. I prefer to speak with an agency representative.

Please take me to a contact page instead.
Please note: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member.
Effective Date:
Policy Number:  
Your Name:  
E-mail:  
Daytime Phone#:  
Choose One:
 
Change Mortgagee or Other Interest: (If change involves more than one lender, please call.)
Loan number: Interest:
New Name:
Address:
City/State/Zip:
Comments:
 
Floater Coverage: (To add or increase floater coverage, please forward sales receipt or appraisal.)
Type of change: Floater type: Describe item(s) and change:
 
Check box to be contacted on any of these options:
 






 
Other changes or comments:
 
It is our policy to make every effort to respond to this request within one business day. Thank you.
Coverage via this online request is NOT bound until you have received an acknowledgement from our office.

Please click on the link below to achnowledge that you have read and understand the above statement.

I understand and agree with the above statement.

I wish to proceed with my quote request. I prefer to speak with an agency representative.

Please take me to a contact page instead.
Please note: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member.

Current Insurance:

Policy Holder:
Name:
Phone:Home Work Cell
Address:
Email: Fax:
DOB: Height: Weight:
Current Medications & Health Conditions:
Spouse:
Name:
DOB: Height: Weight:
Current Medications & Health Conditions:
Children:
DOB:
DOB:
DOB:
DOB:
DOB:
DOB:
Current Medications & Health Conditions:
Comments:
It is our policy to make every effort to respond to this request within one business day. Thank you.
Coverage via this online request is NOT bound until you have received an acknowledgement from our office.

Please click on the link below to achnowledge that you have read and understand the above statement.

I understand and agree with the above statement.

I wish to proceed with my quote request. I prefer to speak with an agency representative.

Please take me to a contact page instead.
Please note: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member.
Effective Date:
Your Name:
Current Address:
 Street
 Prior Address:
(If less than 2yrs at current address) 		Street
City, State & Zip
 City, State & Zip
Phone:
Email:
 
Current coverage: Company:
  		 Expiration Date:
 Liability Limits:
 
Liability Limits and Coverages:
Please select the coverages and limits that are to apply to your vehicles.
Bodily Injury & Property Damage
Uninsured/Underinsured Motorists
Medical Payments
 
Your Vehicles:  
If you have more than four vehicles, please call our office for a quote.
Vehicle 1.
  Year
 Make and model
 VIN (if known):
  Vehicle type
 Vehicle Use
  * Racing/Commercial Unacceptable
  Comprehensive
Custom or modified
Turbocharged
 Total CC's
  Collision
Options:
Vehicle 2.
  Year
 Make and model
 VIN (if known):
  Vehicle type
 Vehicle Use
  * Racing/Commercial Unacceptable
  Comprehensive
Custom or modified
 Turbocharged
 Total CC's
  Collision
Options:
Vehicle 3.
  Year
 Make and model
 VIN (if known):
  Vehicle type
 Vehicle Use
  * Racing/Commercial Unacceptable
  Comprehensive
Custom or modified
 Turbocharged
 Total CC's
  Collision
Options: 
Vehicle 4.
  Year
 Make and model
 VIN (if known):
  Vehicle type
 Vehicle Use
  * Racing/Commercial Unacceptable
  Comprehensive
Custom or modified
Turbocharged
 Total CC's
  Collision
Options: 
 
Driver Information:   If there are more than four drivers, please call our office for a quote.
Driver 1: Driver 2:
Name:
 DOB:
  Sex:
 Name:
 DOB:
  Sex:
Occupation:
 Marital Status:
 Occupation:
 Marital Status:
Accidents or violations in the past 3 years:

 Accidents or violations in the past 3 years:
Driver 3: Driver 4:
Name:
 DOB:
  Sex:
 Name:
 DOB:
  Sex:
Occupation:
 Marital Status:
 Occupation:
 Marital Status:
Accidents or violations in the past 3 years:

 Accidents or violations in the past 3 years:
 
All Drivers:
If a Group Association Discount applies, please enter association name: 
 
Comments:
Please use the box below to enter any additional information you feel should be considered:
Protecting your privacy and identity is very important to us. 
Your Social Security and drivers license number may be required to complete this quote.   Please be sure you have provided an accurate contact number so that we can contact you personally for this information.
It is our policy to make every effort to respond to this request within one business day. Thank you.
Coverage via this online request is NOT bound until you have received an acknowledgement from our office.
Please click on the link below to achnowledge that you have read and understand the above statement.

I understand and agree with the above statement.

I wish to proceed with my quote request. I prefer to speak with an agency representative.

Please take me to a contact page instead.
Please note: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member.
Effective Date:
Your Name:
Current Address:
 Street
 Prior Address:
(If less than 2yrs at current address) 		Street
City, State & Zip
 City, State & Zip
Phone:
Email:
 
Current coverage: Company:
  		 Expiration Date:
 Liability Limits:
 
Liability Limits and Coverages: Please select the coverages and limits that are to apply to your vehicles.
Bodily Injury
Property Damage
Medical Payments
Uninsured Motorists
UM Property Damage
Additional information:
 
Your Vehicles:   If you have more than four vehicles, please call our office for a quote.
Vehicle 1.  
  Year:
 Make and model:
 VIN (if known):
  Vehicle Use
 
  Miles to work/school
Optional Coverages:
  Comprehensive
  Collision
Vehicle 2.
  Year:
 Make and model:
 VIN (if known):
  Vehicle Use
 

Miles to work/school

Optional Coverages:
  Comprehensive
Collision
Vehicle 3.  
  Year:
 Make and model:
VIN (if known):
  Vehicle Use  

Miles to work/school Optional Coverages:
  Comprehensive

Collision
Vehicle 4.
  Year:
 Make and model:
 VIN (if known):
  Vehicle Use
 
  Miles to work/school
Optional Coverages:
  Comprehensive
  Collision
 
Driver Information:   If there are more than four drivers, please call our office for a quote.
Driver 1: Driver 2:
Name:
 DOB:
  Sex:
 Name:
 DOB:
  Sex:
Occupation:
 Marital Status:
 Occupation:
 Marital Status:
Accidents or violations in the past 3 years:

 Accidents or violations in the past 3 years:
Driver 3: Driver 4:
Name:
 DOB:
  Sex:
 Name:
 DOB:
  Sex:
Occupation:
 Marital Status:
 Occupation:
 Marital Status:
Accidents or violations in the past 3 years:


 Accidents or violations in the past 3 years:
 
Household Members: (Non-Drivers)
Name:
 D.O.B.
 Relationship:
 Insurance Carrier:
 Policy Number:
 
Comments:
Please use the box below to enter any additional information you feel should be considered:

Protecting your privacy and identity is very important to us. 
Your Social Security and drivers license number may be required to complete this quote.   Please be sure you have provided an accurate contact number so that we can contact you personally for this information.
It is our policy to make every effort to respond to this request within one business day. Thank you.
Coverage via this online request is NOT bound until you have received an acknowledgement from our office.

Please click on the link below to achnowledge that you have read and understand the above statement.

I understand and agree with the above statement.

I wish to proceed with my quote request. I prefer to speak with an agency representative.

Please take me to a contact page instead.
Please note: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member.
Effective Date:
Your Name:
Current Address:
 Street
 Prior Address:
(If less than 2yrs at current address) 		Street
City, State & Zip
 City, State & Zip
Phone:
Email:
 
Current coverage: Company:
  Expiration Date:
 Coverage Amount:
 
Type of policy desired:  
 
Amount of insurance desired:
Homeowners:  Condo/Renters: 
Current value of your home: Current value of your personal property:
Both Homeowners and Condo/Renters:  
Liability Limit:   
Medical Payments:  
Deductible:  
 
Property Information:
Construction Type:        Year built: 
In what County/Township are you located? 
Distance to the nearest fire hydrant: 
Number of Stories:
Ground floor sq ft:
Total sq ft:
Number of baths: Full   Half
Fireplace:
Central air:
Wood burner: 
Basement:
Percent finished:
Garage:
Porch: If yes, total square footage:
Swimming pool: 
Trampoline:
Pets:  

Home Updates:  Enter year updates were made. If year not known, enter "unknown":
Roof: Wiring: Plumbing: Heating:
 
Optional Property Coverages: Property Floaters - Indicate limits below:


Antiques: Furs:
Coins: Jewelry:
Computers: Stamps:
Fine Arts: Tools:
 
Other Floater Coverage:
Type Limit

Previous Loss Information
Please describe any losses or claims filed on your Homeowners Insurance in the last 3 years. Include the date, type of loss and the amount of the claim.

Additional Comments
Please use the box below to enter any additional information you wish to include:
Protecting your privacy and identity is very important to us. 
Your Social Security and drivers license number may be required to complete this quote.   Please be sure you have provided an accurate contact number so that we can contact you personally for this information.
It is our policy to make every effort to respond to this request within one business day. Thank you.
Coverage via this online request is NOT bound until you have received an acknowledgement from our office.

Please click on the link below to achnowledge that you have read and understand the above statement.

I understand and agree with the above statement.

I wish to proceed with my quote request. I prefer to speak with an agency representative.

Please take me to a contact page instead.
Please note: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member.
Effective Date:
Your Name:
Current Address:
 Street
 Prior Address:
(If less than 2yrs at current address) 		Street
City, State & Zip
 City, State & Zip
Phone:
Email:
 
Plan Desired:
You: Your Spouse:
Term Life: Term Life:
Permanent Life:  Permanent Life: 
Amt. of coverage: Amt. of coverage:
 
Payment Type: 
Monthly or annual premium amount:
Maximum number of years for payment:
 
Options Desired:
Waiver of Premium if Disabled?
Accidental Death Benefit?
Spouse Term Rider?
Amount:
Children’s Life Rider?
Amount:
Return of Premium on Term Plan?
Terminal Illness Accelerated Benefit on Permanent Plan?
Long-Term Care Benefit on Permanent Plan?  
 
Applicant Information:
Applicant:
Spouse:
Date of Birth: Date of Birth:
Height: Height:
Weight: Weight:
Tobacco: Tobacco:
Children:  
#1 Birthdate: #4 Birthdate:
#2 Birthdate: #5 Birthdate:
#3 Birthdate: #6 Birthdate:
 
Present or past treatment or conditions:
Heart disease, cancer or diabetes:
Family history of cardiovascular disease before the age of 60:
Present or past treatment for blood pressure, cholesterol, hypertension, depression:
Sky diving/hang gliding/scuba diving/hazardous occupation:
Current medical condition/medications:  (Please list below)
Current Medications & Dosage (Mg./Day):
 
Additional Questions/Comments
Please use the box below to enter any additional information you wish to include:
Protecting your privacy and identity is very important to us. 
Your Social Security number is required to complete this quote.  We will contact you personally at the number you have provided for this information.
It is our policy to make every effort to respond to this request within one business day. Thank you.
Coverage via this online request is NOT bound until you have received an acknowledgement from our office.

Please click on the link below to achnowledge that you have read and understand the above statement.

I understand and agree with the above statement.

I wish to proceed with my quote request. I prefer to speak with an agency representative.

Please take me to a contact page instead.
Policy Number:  
Your Name:
E-mail:
 
For Which Vehicle(s)?:
(Please call, if ID cards are needed for more than 3 vehicles.) 		Car #1:
Car #2:
Car #3:
 
How should the ID cards be delivered?
  Email ID cards to me at the address shown above
  Fax ID cards to:
  I will pick up the ID cards at your office
  Mail ID cards to: Street

City, State, Zip
It is our policy to make every effort to respond to this request within one business day. Thank you.
Coverage via this online request is NOT bound until you have received an acknowledgement from our office.

Please click on the link below to achnowledge that you have read and understand the above statement.

I understand and agree with the above statement.

I wish to proceed with my quote request. I prefer to speak with an agency representative.

Please take me to a contact page instead.
Your Name:
E-mail:
Telephone Number:
Policy Number:
Named Insured:
 
Certificate Information:
Name of Certificate Holder:
Address of Certificate Holder: Street

City, State, Zip
Project Name/Description:
Special language requirements:
(Requires agency review)
 
How should this certificate be handled?
In consideration of the environment, our preferred method of delivery is E-mail.  If this is not an option, please provide a fax number or mailing address:
Email certificate to:
Please fax the certificate to:
 Fax No: Attn:
I will pick up the certificate at your office.
Please mail to the certificate holder at the address indicated above.
Please mail the certificate to: Name: 
  Address:
It is our policy to make every effort to respond to this request within one business day. Thank you.
Coverage via this online request is NOT bound until you have received an acknowledgement from our office.

Please click on the link below to achnowledge that you have read and understand the above statement.

I understand and agree with the above statement.

I wish to proceed with my quote request. I prefer to speak with an agency representative.

Please take me to a contact page instead.
Please note: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member.
Effective Date:
Your Name:
Current Address:
 Street
 Prior Address:
(If less than 2yrs at current address) 		Street
City, State & Zip
 City, State & Zip
Phone:
Email:
 
Description of Property:
      
Motor type:
 Number of Engines:
 Boat Type:
 Other Boat Type
Fuel:
 Maximum Speed:
 Hull Material:
 Other Hull Material:
 
Insured Watercraft:
Boat:  Year Manufacturer Model  Serial Number TotalHP Length

O/B Motor: Year Manufacturer Model  Serial Number TotalHP  
   
Trailer:
 		Year  Manufacturer     Serial Number    
       
Is the boat chartered or used for other than private pleasure purposes?   
 
Coverage:   Limits: Optional Coverages:
Boat (incl. aux equip) Agreed Value Endorsement
Actual Cash Value
Fishing Equipment Limit:  
O/B Motor 1.  (ACV Coverage)
O/B Motor 2.  (ACV Coverage)
Boat Trailer 
Pers. Property  ($500 Automatic)
Towing  ($400 Automatic)
Boat Liability
Medical Payments  ($1000 Automatic)
Uninsured Boater
 
Safety Equipment:
GPS
Automatic CO2 (Halon)
Ship to Shore Radio (VHF)
 Depth Sounder
Electronic Burglar Alarm
Radar
 Plotter
EPIRB
Vapor Detector Alarm
 
Operator Information:
Date of Birth:
Years of boating experience:
Waters to be Navigated:
 		 
Inland waters of the following states:
Coastal waters of the following states:

Previous Loss Information
Please describe any losses or claims filed on your Boat Insurance in the last 3 years. Include the date and type of the loss, as well as the amount of the claim.
 
Additional Comments
Please use the box below to enter any additional information you wish to include:
Protecting your privacy and identity is very important to us. 
Your Social Security and drivers license number may be required to complete this quote.   Please be sure you have provided an accurate contact number so that we can contact you personally for this information.
It is our policy to make every effort to respond to this request within one business day. Thank you.