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Auto & Home Insurance Quote

Your Information
Name
Phone
Email
Date of Birth
MM slash DD slash YYYY
Driver's License State & Number
Marital Status
Referred by
Second Insured Information
Name
Date of Birth
MM slash DD slash YYYY
Driver's License State & Number
Home Information
Property Address
Current Address
Type of Home
Refinance or Purchase?
If Purchase, list Estimated Date of Closing
If Refinance, list Current Insurance Company
Any Planned Renovations?
- Yes
- No
If Yes, please explain what type of work and an estimated amount of the cost.
Year Roof was Replaced?
Year HVAC was Replaced?
Year Electrical was Updated?
Year Plumbing was Updated?
Any Pets?
- Yes
- No
If Yes, list Breed
Pool, trampoline, diving board and/or slide?
Additional Drivers
Add Driver
Full Name D.O.B. Gender License State License Number
Vehicles
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Make/Model Annual Miles Driven Usage (work, pleasure, business) Assigned Driver
Have you had continuous insurance for at least 6 months?
- Yes
- No
If Yes, list Current Insurance Company
Physical Damage (Full Coverage)
- Yes
- No
Additional Comments
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Bahr Insurance Agency

23278 Three Notch Road
California, Maryland 20619

Phone: (301) 737-3038

Fax: (240) 718-2829

Mon-Fri: 8:30am-4:30pm
Sat-Sun: Closed

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Local Erie Insurance Agent

Bahr Insurance Agency Provides Auto, Home, Business, and Life Insurance to All of Maryland, Including California, Lexington Park, Great Mills, Leonardtown, Mechanicsville, Lusby, Solomons, St. Leonard; St. Mary's County, Calvert County, and Charles County.

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