Proudly serving New Brunswick for more than 35 years!



Français

Auto Insurance - Quote Request


Automobile Insurance

Name:
Address:
City:
Province:
Postal Code:
Telephone Number:
Email:
Have you ever had your insurance cancelled or refused?    
Are you currently insured?    
If not, have you been insured for 12 consecutive months, without interruption in the last 10 years?    
Beginning of required coverage:
Driver Information: #1 #2 #3
Name Driver(s):
Date of Birth:
Driver's license number:
How many years have you been licensed in Canada?
What class is your driver's license?
Sex:
Marital Status:
Did you take a driving course?
Are You Retired?
How many minor driving violations have you had in the last three (3) years?
How many major driving violations have you had in the last three (3) years (dangerous driving, impaired driving etc.)?
What is the name of your previous insurer?
Have you or any driver named above had a driver's license suspension in the last 10 years?    
Have you or any driver named above had any accidents or claims in the last 10 years?    
Claim Details: Claims Date (mm/AAAA) Driver Involved
#1:
#2:
#3:
 
Vehicle Information: Vehicle #1 Vehicle #2
Make:
Year:
Model:
Style:
Usage:
Number of KM to Work:
Annual Mileage:
Primary Driver:
 
Vehicle #1 Vehicle #2
Liability:
Franchise pour collision:
Franchise pour comprehension:
 
In order to be able to give you a more accurate quote, please reply to all questions.