At Coe Insurance can provide superior coverage for your collector vehicle, but at a price much lower than your regular auto insurance carrier can offer. We know that you want to keep your vehicle in great shape; and we reward you with a great rate.

Because we understand the unique value ascribed to collectible autos, we provide Agreed Value Coverage. Which means that you and Coe Insurance establish the value of your particular vehicle based on current market, history, quality and restoration and overall condition. We have high limits of liability available including coverage for uninsured motorist and medical expenses, to best protect your classic auto.

If you answered "yes" to all the eligible questions, your likely eligible for coverage. If you answered "no" to any of the questions, please feel free to call us at 201-435-4300 to discuss your options with one of our representatives.

Information submitted will be held confidential and will be used for quote purposes only. Submission of application information in no way obligates you to purchase any product or insurance, nor does it represent any agreement to provide coverage under any insurance policy.

Personal Information First Name: Last Name: E-Mail: Phone Numbers: Daytime: Evening: Fax: Contact Preference: Daytime Evening Fax E-Mail When is the best time to reach you?: Address: City: State: Zip Code: Do you currently own your home or rent? Own Rent Driver's License Number: Social Security Number: (optional) Drivers Information - Please list all individuals who will drive the Classic Auto   Name: Relationship to applicant: Sex: Marital Status: Driver's Age: Percent Use: Driver #1 Select One Self Husband Wife Son/Daughter Other Male Female Married Single Driver #2 Select One Self Husband Wife Son/Daughter Other Male Female Married Single Driver #3 Select One Self Husband Wife Son/Daughter Other Male Female Married Single Driver #4 Select One Self Husband Wife Son/Daughter Other Male Female Married Single Drivers History Who is the Primary Insurance Carrier?: Please answer the below 4 questions about you or any other driver in your household: Had a ticket in the last 3 years? Yes No Had a license suspended or revoked in the last 6 years? Yes No Had a financial responsibility filing in the last 6 years? Yes No Made any claims in the last 5 years? Yes No If you answered yes to any of the above questions, please explain: Classic Auto Information Year: Make: Model: VIN: Primary Driver: Select One 1 2 3 4 Annual Mileage: Appox. Value: Is the vehicle driven to school or work? Yes No If driven to school or work, how many weeks per month? Days: Weeks: If driven to school or work, how many miles one way? Miles: Is the vehicle in any way modified or customized? Yes No Is there any existing damage to the vehicle? Yes No If the vehicle is kept at an address other than that listed above, please indicate below: Address: City: State: Zip Code: Coverage Options Bodily injury liability: Select One $15,000 per person / $30,000 per accident $25,000 per person / $50,000 per accident $50,000 per person / $100,000 per accident $100,000 per person / $300,000 per accident $250,000 per person / $500,000 per accident Property damage liability: Select One $25,000 per accident $50,000 per accident $100,000 per accident $250,000 per accident Underinsured motorist-bodily injury: Select One $15,000 per person / $30,000 per accident $25,000 per person / $50,000 per accident $50,000 per person / $100,000 per accident $100,000 per person / $300,000 per accident $250,000 per person / $500,000 per accident Underinsured motorist-property damage: Select One $15,000 per person / $30,000 per accident $25,000 per person / $50,000 per accident $50,000 per person / $100,000 per accident $100,000 per person / $300,000 per accident $250,000 per person / $500,000 per accident Medical-Personal injury protection: Select One $250,000 (standard) $150,000 for a 9.7% to 10.2% reduction $75,000 for a 17.5% to 18.6% reduction $50,000 for a 19.4% to 20.4% reduction $15,000 for a 24.4% to 25.9% reduction Do you want your health carrier to be the primary payer of health expenses?: Select One Yes No Coverage Deductibles   Comprehensive Deductible Collision Deductible Classic Auto #1: Select One $250, min required by law $500 $1,000 $2,000 $2,500 Select One $1,000 $1,500 $2,000 Questions, Comments or Additional Automobile Information?