Home • Get A Quote • About Us • Insurance Products • Info Centre • Careers	Change Text Size

Getting a quote on-line is easy! Simply fill out the form below and click on submit. If you would prefer to speak with a registered insurance broker, call 1 866 473 9650.

1) Contact Information

Name:	*
Street:
City:
Province:
Postal Code:
Day Time Telephone Number:	*
Evening Telephone Number:	*
Cellular Telephone Number:
Fax Number:
E-Mail Address:	*
Best time to call:
Expiry Month of Current Policy:	*

2) Vehicle #1 Information

Year:
Manufacturer:
Model:
Body type:
Primary use of the vehicle?
If the use is primarily for commuting to and from work, what is the distance one way?

3) Driver Information

Item	Principal Driver	Occasional Driver
Date of Birth (YYYY-MM-DD)
Sex
Marital Status
How many 'at fault' accidents? (last 6 years)
Date of last 'at fault' accident? (YYYY-MM-DD)
How many 'not at fault accidents'? (and other claims in the last 6 years)
How many traffic tickets? (excluding parking tickets in the last 3 years)
Any convictions for careless or dangerous driving, or impaired/blood alcohol level? in the last 3 years?
Any license suspensions? (for any reason, in the last 5 years?)
Years licensed in Canada or USA?
Which statement describes you best? Continuously insured more than 6 years. Continuously insured less than 6 years. Not insured now, had my own policy in the past. Not insured now, named on someone else's policy in the past. Have never held auto insurance.

4) Coverage Information

Liability Limit:
All Perils Deductible:
If you chose "No Coverage" under All Perils Deductible above, please select "No Coverage" for Collision Deductible and Comprehensive Deductible below.
Collision Deductible:
Comprehensive Deductible:

5) Endorsements

Loss of Use:
Damage to non owned automobiles:
Waiver of Depreciation: (only available to vehicles 2 years old or newer)

6) Other Coverage Required

Please describe coverage:

7) Vehicle #2 Information

Year:
Manufacturer:
Model:
Body type:
Primary use of the vehicle?
If the use is primarily for commuting to and from work, what is the distance one way?

8) Driver Information

Item	Principal Driver	Occasional Driver
Date of Birth (YYYY-MM-DD)
Sex
Marital Status
How many 'at fault' accidents? (last 6 years)
Date of last 'at fault' accident? (YYYY-MM-DD)
How many 'not at fault accidents'? (and other claims in the last 6 years)
How many traffic tickets? (excluding parking tickets in the last 3 years)
Any convictions for careless or dangerous driving, or impaired/blood alcohol level? in the last 3 years?
Any license suspensions? (for any reason, in the last 5 years?)
Years licensed in Canada or USA?
Which statement describes you best? Continuously insured more than 6 years. Continuously insured less than 6 years. Not insured now, had my own policy in the past. Not insured now, named on someone else's policy in the past. Have never held auto insurance.

9) Coverage Information

Liability Limit:
All Perils Deductible:
If you chose "No Coverage" under All Perils Deductible above, please select "No Coverage" for Collision Deductible and Comprehensive Deductible below.
Collision Deductible:
Comprehensive Deductible:

10) Endorsements


Loss of Use:
Damage to non owned automobiles:
Waiver of Depreciation: (only available to vehicles 2 years old or newer)

11) Other Coverage Required

Please describe coverage:

12) Please enter any questions or comments: