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  • PROPERTY INSURANCE
  • RESOURCES
  • COMMUNITES
  • CONTACT

Manual Auto Quote Form

Manual Auto Quote Formadminpower2020-10-27T20:30:29+00:00
  • Pre-Requisite Questions

  • Sorry, you must be a resident of Ontario Canada to apply for a quote.

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  • Sorry, we cannot provide insurance for vehicles used for Uber driving.

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  • Sorry, we cannot insure vehicles over 20 years of age.

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  • Sorry, this form can only accept up to two vehicles. We can still provide you a quote by telephone. Please call our office directly 1.877.373.3133.

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    Drivers include anyone over the age of 16 that live in the same household who DO NOT have their own auto insurance.
  • Sorry, this form can only accept up to two vehicles and three drivers. We can still provide you a quote by telephone. Please call our office directly 1.877.373.3133.

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  • Applicant Information (Driver #1)

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  • Vehicle #1 Information

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  • Vehicle #2 Information

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  • Applicant (Driver #1) Information

  • MM slash DD slash YYYY
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  • Applicant (Driver #1) Driving History

  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
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  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
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  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
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  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
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  • Driver #2 Information

  • MM slash DD slash YYYY
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  • Driver #2: Driving History

  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
Save and Continue Later
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
Save and Continue Later
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
Save and Continue Later
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
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  • Driver #3 Information

  • MM slash DD slash YYYY
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  • Driver #3: Driving History

  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
Save and Continue Later
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
Save and Continue Later
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
  • DD slash MM slash YYYY
Save and Continue Later
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
  • DD slash MM slash YYYY
    Enter 1st day of the month if unsure of the exact date.
Save and Continue Later
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  • Phew ... all done!

  • Please let us know if you have any additional information or comments.
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