Auto Insurance Quote

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  • How did you hear about us?
  • Referral
  • Social Media
  • Google
  • Newspaper
  • Billboard
  • Other
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  • - Select A Province -
  • Ontario
  • Quebec
  • British Columbia
  • Alberta
  • Manitoba
  • Saskatchewan
  • Nova Scotia
  • New Brunswick
  • Newfoundland and Labrador
  • Prince Edward Island
  • Northwest Territories
  • Nunavut
  • Yukon
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  • How would you like us to contact you?
  • Phone
  • Email
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Do you have an Agent preference?
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Vehicle

Use the Green Plus Sign (+) at the bottom to add additional vehicles.
Year
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Make
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Model
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Vehicle Use
  • Pleasure
  • Pleasure
  • Business
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Daily Commute (One Way)
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Vehicle Insurance Number (VIN):
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Winter Tires?
  • Yes
  • No
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Liability Limit:
  • $1,000,000
  • $2,000,000
  • $3,000,000
  • $5,000,000
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Driver

Use the Green Plus Sign (+) at the bottom to add additional drivers.
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Address
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Name of Driver
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Date of Birth:
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Marital Status:
  • - select an option -
  • Single
  • Married
  • Common Law
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Drivers Education Training?
  • - select an option -
  • Yes
  • No
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Driver License Number:
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Current License Class
  • G
  • G
  • G2
  • G1
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Date you attained your G1 licence?
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Date you attained your G2 licence?
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Date you attained your G licence?
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How Many Tickets In The Last 3 Years?
  • None
  • None
  • 1
  • 2
  • 3+
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Has Your License Been Suspended?
  • - select a option -
  • Yes
  • No
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Which vehicle is this driver assigned to?
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How Many Years Have You Had Continuous Auto Insurance?
  • 0
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6+
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How Many At Fault Accients In The Last 6 Years?
  • None
  • None
  • 1
  • 2
  • 3+
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Has Your Auto Insurance Ever Been Cancelled For Any Reason?
  • No
  • Yes
  • No
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Comments
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