To receive a free no obligation quotation, simply fill out all of the required fields.  An estimation of your premium will be e-mailed back to you within the next 48 hours.

The following forms are for quotation purposes only and they are not to be considered as an application for insurance nor a policy of insurance.

 

Name: E-mail: Renewal Date:
Province: Ontario City: Postal Code:
Telephone:

Best time to be contacted: Monday Tuesday Wednesday Thursday Friday 

9am-12pm  12pm-4pm 4pm-7pm

Driver ages:  #1 #2  #3
Marital Status: #1  #2  #3
Gender: #1 #2 #3
Years Licensed in Ontario #1 #2 #3
Vehicle Information:
Model Year #1 #2 #3
Make of Motorhome #1 #2 #3
Model  #1 #2 #3
Purchase Price #1 #2 #3
Coverage Section
Liability: (none signifies coverage not required)
#1  #2  #3 
Collision Deductible: (none signifies coverage not required)
#1  #2  #3 
Comprehensive Deductible: (none signifies coverage not required)
#1  #2  #3 
Specified Perils: (Fire & Theft) instead of above
#1 #2 #3
Has any insurance company cancelled automobile insurance in the last three years:  yes no
Has any of the drivers had a license suspension or been cancelled in the past six years:  yes  no
If yes, give details:
During the last 3 years, has any automobile insurance policy issued to the applicant or driver been cancelled or had a claim denied for material misrepresentation:    yes no
If yes, give details: 
Has any applicant or driver been found by a court to have committed a fraud connected with automobile insurance: yes no
If yes, give details:
Give details of all convictions of the applicant and any drives arising from the operation of any automobile in the last three years:
Have you or any drivers in the past six years had any accidents:
An not at fault accident: yes no An at fault accident: yes no
If yes, please give the following details for each claim:
Date of loss: Which driver: Amount of claim:
Details:

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