Online Auto Quote

​Get an Online Auto Insurance Quote

​Simply fill out the form below to request an auto insurance quote. One of our insurance experts will review your request and will be in touch shortly.

Your Personal Information

Name:*
Phone:*
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E-mail:*
Address:*
Do you belong to a professional association? If so, which one?
Preferred Contact Method:*
What's the best time of day to reach you by phone?

Vehicle #1

Vehicle Year:*
Make & Model:*
Purchase Date:*
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When does your current auto insurance policy renew?*
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VIN:
Annual KM:*
Commute Distance:*
Principal Operator:*
Snow Tires:*

Vehicle #1 Coverage Requests

Please make your choices from the options below:

Coverage Amount Requested:*
Collision Deductible: *
Comprehensive Deductible:*
Medical Rehabilitation and Attendant Care:*
Caregiver, Housekeeping and Home Maintenance:*
Income Replacement:*
Dependent Care:*
Increased Death and Funeral:*
Indexation Benefit:*
Tort Deductible:*
Other Coverages:

Vehicle #2 (optional)

Vehicle #2 Year:
Make & Model #2:
Purchase Date #2:
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When does your current auto insurance policy renew for vehicle #2
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VIN #2:
Annual KM #2:
Commute Distance #2:
Principal Operator #2:
Snow Tires #2:

Vehicle #2 Coverage Requests (optional)

Coverage Amount Requested (Vehicle #2):
Collision Deductible (Vehicle #2):
Comprehensive Deductible (Vehicle #2):
Medical Rehabilitation and Attendant Care (Vehicle #2):
Caregiver, Housekeeping and Home Maintenance (Vehicle #2):
Income Replacement (Vehicle #2):
Dependent Care (Vehicle #2):
Increased Death and Funeral (Vehicle #2):
Indexation Benefit (Vehicle #2):
Tort Deductible (Vehicle #2):
Other Coverage (Vehicle #2):

Driver #1

Driver #1 Name:*
Driver #1 Birthdate:*
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Driver #1 License #:*
Driver #1 License Type:*
Driver #1 G1 License Date:*
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Driver #1 G2 License Date:
 / 
 / 
Driver #1 Driver's Training Completed:*
Driver #1 Accidents (Please list dates and details from any accidents in the past 20 years):
Driver #1 Convictions (Please list any in the past 3 years, including the conviction date):
Driver #1 Suspensions (Please list any in the past 6 years):
Driver #1, has there been any time while you have been licensed that you did not have insurance? If so, please explain:
Driver #1, have you had any policies cancelled for non-payment within the last 3 years? If so, please provide the date and details:
Driver #1 First Insured Date:*
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Driver #1 Current Policy Active Since:*
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Driver #2 (optional)

Driver #2 Name:
Driver #2 Birthdate:
 / 
 / 
Driver #2 License #:
Driver #2 License Type:
Driver #2 G1 License Date:
 / 
 / 
Driver #2 G2 License Date:
 / 
 / 
Driver #2 Driver's Training Completed:
Driver #2 Accidents (Please list dates and details from any accidents in the past 20 years):
Driver #2 Convictions (Please list any in the past 3 years, including the conviction date):
Driver #2 Suspensions (Please list any in the past 6 years):
Driver #2, has there been any time while you have been licensed that you did not have insurance? If so, please explain:
Driver #2, have you had any policies cancelled for non-payment within the last 3 years? If so, please provide the date and details:
Driver #2 First Insured Date:
 / 
 / 
Driver #2 Current Policy Active Since:
 / 
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