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Auto Quote Form CW

  • Registered Vehicle Owner

    This will be the policy owner and must be the registered owner of the vehicle to be insured.
  • Address the vehicle will be registered to when your policy becomes effective.
  • Requested Policy Start Date
    MM slash DD slash YYYY
  • Vehicle #1 Details

  • Only automobiles, we have a separate form for motorcycles, ATV's, snowmobiles.
  • Be as specific as possible for most accurate quote.
  • Providing a VIN is not mandatory but will increase accuracy of the quote.
  • What status was the vehicle when you purchased it?
  • What year was the vehicle purchased?
  • Roughly how many KM's were on the vehicle when you purchased it?
  • How many KM's do you expect to put on the vehicle over the course of the next year?
  • Distance one-way from home to work.
  • What type of tire do you use in the winter?
  • If financed or leased full coverage is mandatory.
  • If any pre-existing damage please be as detailed as possible explaining the damage.
  • Vehicle #2 Details

  • Be as specific as possible for most accurate quote.
  • Providing a VIN is not mandatory but will increase accuracy of the quote.
  • What status was the vehicle when you purchased it?
  • What year was the vehicle purchased?
  • Roughly how many KM's were on the vehicle when you purchased it?
  • How many KM's do you expect to put on the vehicle over the course of the next year?
  • Distance one-way from home to work.
  • What type of tire do you use in the winter?
  • If financed or leased full coverage is mandatory.
  • If any pre-existing damage please be as detailed as possible explaining the damage.
  • Vehicle #3 Details

  • Be as specific as possible for most accurate quote.
  • Providing a VIN is not mandatory but will increase accuracy of the quote.
  • What status was the vehicle when you purchased it?
  • What year was the vehicle purchased?
  • Roughly how many KM's were on the vehicle when you purchased it?
  • How many KM's do you expect to put on the vehicle over the course of the next year?
  • Distance one-way from home to work.
  • What type of tire do you use in the winter?
  • If financed or leased full coverage is mandatory.
  • If any pre-existing damage please be as detailed as possible explaining the damage.
  • Vehicle #4 Details

  • Be as specific as possible for most accurate quote.
  • Providing a VIN is not mandatory but will increase accuracy of the quote.
  • What status was the vehicle when you purchased it?
  • What year was the vehicle purchased?
  • Roughly how many KM's were on the vehicle when you purchased it?
  • How many KM's do you expect to put on the vehicle over the course of the next year?
  • Distance one-way from home to work.
  • What type of tire do you use in the winter?
  • If financed or leased full coverage is mandatory.
  • If any pre-existing damage please be as detailed as possible explaining the damage.
  • Driver #1 Details

  • MM slash DD slash YYYY
  • Certain occupations qualify for preferred rates, be as detailed as possible.
  • If you successfully completed driver training in Ontario and can provide a certificate you will receive a discount.
  • Parking tickets don't count.
  • Driver #2 Details

  • MM slash DD slash YYYY
  • Certain occupations qualify for preferred rates, be as detailed as possible.
  • If you successfully completed driver training in Ontario and can provide a certificate you will receive a discount.
  • Parking tickets don't count.
  • Driver #3 Details

  • MM slash DD slash YYYY
  • Certain occupations qualify for preferred rates, be as detailed as possible.
  • If you successfully completed driver training in Ontario and can provide a certificate you will receive a discount.
  • Parking tickets don't count.
  • Driver #4 Details

  • MM slash DD slash YYYY
  • Certain occupations qualify for preferred rates, be as detailed as possible.
  • If you successfully completed driver training in Ontario and can provide a certificate you will receive a discount.
  • Parking tickets don't count.
  • Driver #5 Details

  • MM slash DD slash YYYY
  • Certain occupations qualify for preferred rates, be as detailed as possible.
  • If you successfully completed driver training in Ontario and can provide a certificate you will receive a discount.
  • Parking tickets don't count.
  • Upload / Comments

  • Optional feature, upload picture of vehicle, ownership, driver's license, etc.
    Drop files here or
    Max. file size: 50 MB.
    • Include any additional comments.
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