Car Insurance Quote

Name:

Address:

City:

Province:

Postal Code:

Phone:

Email:

Age of principal driver:

Marital status of principal driver: —Please choose an option—MarriedSingle

Number of years licensed for principal driver:

Gender of additional drivers under 25 years of age: —Please choose an option—MaleFemale

Do driver(s) under 25 years of age have driver training certification:
—Please choose an option—YesNo

Any driving convictions in past 3 years:
—Please choose an option—YesNo

If yes, # of convictions:

Do you use your vehicle for business:
—Please choose an option—YesNo

Do you use your vehicle to commute to and from work:
—Please choose an option—YesNo

Year, make and model of vehicle:

Liability limit requested: $2,000,000$1,000,000

Coverage Preferred: All perilsCollisionComprehensiveSpecific perils

Deductible: $500$250$1000

Additional vehicles to be quoted:
—Please choose an option—YesNo

How many years have you consistently had an auto policy in force or been listed on someone else's policy as a listed driver:

Number of at fault claims in the past 10 years:

How many years since last at fault claim (if within 10 years):

What is your occupation:

How many kilometers do you commute to work 1 way:

Was your prior policy canceled for non-payment:
—Please choose an option—YesNo

Was your policy lapsed for any other reason by the insurance company:

Which insurance company has your current property insurance: