Quick Quote Form

First Name	Last Name

Email:

Phone:

Zip:

Interest:

CEK Insurance
1011 Westdale
Lawrence, KS 66049
Phone: 785-843-2772
Fax: 785-843-1583

Gladstone Location
2900 NE 60th St
Gladstone, MO 64119
Phone: 816-453-8584

Claim Form

Your Name:

First	Last

Email Address:

Phone Number:

5 Digit Zip:

Policy Number:
Date of Loss:
Time of Loss:
Location of Incident/Loss:
Description of Incident/Loss:
Were the Authorities Called?
Additional Information:

By clicking submit, I understand this is not an actual claim, but notification to my agent to help with the process of my claim.

Note: By submitting this form you understand that no coverage is bound until you receive written notice. You also agree to release us from any liability if this information is accidentally viewed by unauthorized persons. We will only use this information for insurance quoting purposes and not distribute to other parties.

1011 Westdale Lawrence, KS 66049 | Phone: 785-843-2772 | Fax: 785-843-1583 | Email Us | Get Map

2900 NE 60th St Gladstone, MO 64119 | Phone: 816-453-8584 | Email Us | Get Map

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