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  • 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.
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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 #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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Accidents

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Impaired Driving

Charged with impaired driving and can’t find insurance? We can help. Get an instant online quote today.

Speeding Tickets

Have you been classified as a high risk driver because of too many speeding tickets? We can help. Get an instant online quote today.

Multiple Tickets

Multiple tickets on your driving record? We can help. Get an instant online quote today.

Careless or Stunt Driving

Problems with insurance due to careless or stunt driving? We can help. Get an instant online quote today.

Non-Payment

Has your insurance been cancelled for non-payment? We can help. Get an instant online quote today.
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