Life, Health, Disability or Long Term Care
Insurance Quote Request

In an effort to give you as accurate an estimate of your premium as possible, we will need to ask enough questions up front, including information on your health, family history and life-style. It is important for you to answer the questions honestly and completely. If you choose to then apply for the coverage the information obtained during the underwriting process may result in a different actual premium being offered than what is presented in the estimate.

If you have had difficulty obtaining insurance for any reason CPFS can help. Through our alliance with Maryland Agency Insurance Associates (MAIA) CPFS has access to over 25 different insurance companies that have been identified as not only competitive but highly rated in the insurance industry.

Upon submitting the following information we will compare the rates of the companies available to us at no cost or obligation to you.

Within the past two years have you:

Flown or taken instruction as a pilot or crew member or do you intend to do so?
yes no

Engaged in any kind of racing, scuba or sky diving, hang gliding, mountain climbing, ballooning, para-sailing, ultra-light flying or do you intend to do so?
yes no

Been involved in a hazardous occupation such as underground mining, explosive handling, high-risk construction work or high-risk professional sports?
yes no

Been found guilty of a moving violation or had your drivers license restricted or revoked with the last five years?
yes no

Used tobacco products in any form (cigarettes, dip, snuff, chewing tobacco, pipe tobacco) or any other nicotine substitute in the past 36 months?
yes no

Check any of the following conditions for which you have been treated or sought treatment within the past 10 years:

Did your mother father, or sibling die before age 60 of cardiovascular disease, diabetes or cancer?
yes no

Within the last five years has a licensed physician treated you for, or diagnosed you as having, Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC)?
yes no

Are you a US Citizen or do you hold a resident alien status?
yes no

Do you plan to reside or travel outside the United States within the next two years?
yes no

Have you ever been rated for life insurance in the past?
yes no

Thank you for answering the preceding questions, your answer will be forwarded to a representative of CPFS who will process the information and contact you within two business days. If you have not received a reply within the allotted two business days please don't hesitate to contact us at 301-863-7071 ext. 227 or 228 or e-mail us at cpfs@cpfcu.com

Please Note:
Email is not a secure means of transmitting data.
Please do not provide any sensitive personal information (i.e., SSN, Date of Birth, account number).