Get a Quote – Auto

Auto Insurance Quote Request

Get a Quote - Auto
Have you ever had any cancellations, accidents, tickets, or gaps in insurance in the last 6 years? *
Address *
Postal Code
Do you own a home or rent? *

As your broker, I am gathering this consent on behalf of the insurer who advises me that: in respect of this quotation/application, any policy we issue and subsequent renewals or changes, we may collect,use and disclose personal information reports including policy history, claims history, investigative information, rating information, risk information and only with respect to you, your personal credit information including credit score, as permitted by law and in accordance with our privacy policies.

Do you, and on behalf of others listed, authorize use to collect, use and disclose to appropriate third parties, including your broker, this information solely relating to your personal property policy for the purposes necessary to assess the risk, determine a premium, determine eligibility and conditions for a premium payment plan, investigate and settile claims, analyze business results and detect and prevent fraud?

Do you agree with the following consent statement? *

Vehicle Information


How did you purchase your vehicle? *
Is the vehicle leased or financed? *
Liability *
Loss / Damage *

Distance Driven

Business Use *
Click 'Add' if you like to add another vehicle.


Sex *
Click 'Add' if you like to add another driver.

Additional Information

Are you interested in any of the following insurance products? *

The information on this application is true and correct to the best of my knowledge. 
I authorize the person to whom this application is delivered to perform a soft credit check. I understand that a soft credit check is a non-intrusive test that does not affect my credit score and will not increase my insurance premium, only add additional savings. This information will be used strictly for the purposes of verifying information and will be held in confidence.

Do you agree with the following consent statement? *

Please contact our office to speak with a representative at 1-866-466-9660