Telephone: (506)738-8441

Toll Free: 1-877-738-8441

Fax: (506)738-2871

 

Long term staff have played a major role in our success.

Name

Telephone

Postal Code

Vehicle # 1

Year

Make

Model

Use of Vehicle

# km to work

# km/year

Collision Deductible

Liability Amount

Comprehensive Deductible

Vehicle #  2

Year

Make

Model

Use of Vehicle

# km to work

# km/year

Collision Deductible

Liability Amount

Comprehensive Deductible

To insure more than 3 vehicles, please contact one of our sales representatives

Driver #1

Name

Date of Birth

Gender

Marital Status

Drivers Licence Number

License Class

# Years Licenced

Driver Training

# uninterrupted years insurance

Renewal date

# claims (not accidents) in the past 6 years

# accidents in the past 6 years

Have you ever had your insurance cancelled?

Any convictions in the past 3 years?

Has your drivers licence ever been suspended?

Driver #2

Name

Date of Birth

Gender

Marital Status

Drivers Licence Number

License Class

# Years Licenced

Driver Training

# of uniterrupted years insurance

Renewal date

# claims (not accidents) in the past 6 years

# accidents in the past 6 years

Have you ever had your insurance cancelled?

Any convictions in the past 3 years?

Has your drivers licence ever been suspended?

If more than 2 drivers live in your house, please contact one of our representatives for a quote

Thank you for taking the time to fill out our online quote form.  One of our representative will contact you soon.