Not Sure Which Location is Closest to You?Take a look at our locations map to find the office that is right for you!Find a Location! Step 1 of 3 33% GENERAL INFORMATIONCompany Name*Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Email* Daytime Phone*Business Type*Ref by:*POLICY INFORMATIONDo you have a current commercial auto policyLegally binding contract effecting insurance or certificates thereof, including all clauses, riders, endorsements and renewals. More?*YesNoDate* Date Format: MM slash DD slash YYYY Name of Current or Most Recent InsurerThe company providing the insurance coverage. More*PolicyLegally binding contract effecting insurance or certificates thereof, including all clauses, riders, endorsements and renewals. More RenewalA certificate which attests to the fact that an insurance policy has been extended for another term. More Date or Date Last InsuredThe entity (individual or otherwise) whose risk of financial loss from an insured peril is protected by the insurance policy. More* Date Format: MM slash DD slash YYYY PolicyLegally binding contract effecting insurance or certificates thereof, including all clauses, riders, endorsements and renewals. More cancelled in the last 3 years?YesNoIf yes, state reason and date:* VEHICLE #1 INFORMATIONRegistered Name for Vehicle*Type:*Personal NameCompany NameYear*Make*Model*Body Type*Please Select One2-DoorConvertible4-DoorStation WagonPickupVanOtherIf Other, Please Specify:*Date of Vehicle Purchase*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920VIN #:*Weight of Vehicle*More than 4500kgLess than 4500kgList Price New*Is Vehicle:*OwnedLeasedAny Business in U.S.?*YesNoPercentage of use in U.S.*Please Describe Main Usage for Vehicle*Liability Limit*Please select one$1,000,000$2,000,000Collision Deductible*Please Select One$300$500$1,000$2,500$5,000Comprehensive Deductible*Please Select One$300$500$1,000$2,000$5,000Loss of Use:*YesNoLimited WaiverThe intentional relinquishment of a known right. A waiver under a policy is required to be clearly expressed and in writing. More of DepreciationReduction in value of property through use, ageing, deterioration and obsolescence. More*YesNoLegal LiabilityLiability imposed by law on individuals or corporations to pay for harm done to others. Such law may be the common law, statute law or customs which o... More For Non-Owned Vehicles*YesNo List Machinery & Equipment:Description*Year Manufactured*Value*Description:Year ManufacturedValue:Description:Year ManufacturedValue:Haul any trailers?*YesNoUse of TrailerTrailer TypeTrailer YearTrailer MakeTrailer ModelTrailer ValuePlease list the merchandise carried:Are goods carried for compensation?*YesNoIf yes, is there a contract in place?*YesNoHauling for others?*NeverDailyWeeklyIf yes, is there a contract in place?*YesNo Radius of Operations:Normal Radius: Distance one way (kms):*% of total trips:*Maximum Radius: Distance one way (kms):*% of total trips:*Number of trips per month outside of radius:*Destinations Travelled to: (Cities, Provinces)*Garaged Location of Vehicle*Have second vehicle?YesNoVEHICLE #2 INFORMATIONRegistered Name for Vehicle*Type:*Personal NameCompany NameYear*Make*Model*Body Type*Please Select One2-DoorConvertible4-DoorStation WagonPickupVanOtherIf Other, Please Specify:*Date of Vehicle Purchase*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920VIN #:*Weight of Vehicle*More than 4500kgLess than 4500kgList Price New:*Is Vehicle:*OwnedLeasedAny Business in U.S.?*YesNoPercentage of use in U.S.*Please Describe Main Usage for Vehicle*Liability Limit*Please select one$1,000,000$2,000,000Collision Deductible*Please Select One$300$500$1,000$2,500$5,000Comprehensive Deductible*Please Select One$300$500$1,000$2,000$5,000Loss of Use:*YesNoLimited WaiverThe intentional relinquishment of a known right. A waiver under a policy is required to be clearly expressed and in writing. More of DepreciationReduction in value of property through use, ageing, deterioration and obsolescence. More*YesNoLegal LiabilityLiability imposed by law on individuals or corporations to pay for harm done to others. Such law may be the common law, statute law or customs which o... More For Non-Owned Vehicles*YesNo List Machinery & Equipment:Description:*Year Manufactured*Value:*Description:Year ManufacturedValue:Description:Year ManufacturedValue:Haul any trailers?*YesNoUse of TrailerTrailer TypeTrailer YearTrailer MakeTrailer ModelTrailer ValuePlease list the merchandise carried:Are goods carried for compensation?*YesNoIf yes, is there a contract in place?*YesNoHauling for others?*NeverDailyWeeklyIf yes, is there a contract in place?*YesNo Radius of Operations:Normal Radius: Distance one way (kms):*% of total trips:*Maximum Radius: Distance one way (kms):*% of total trips:*Number of trips per month outside of radius:*Destinations Travelled to: (Cities, Provinces)*Garaged Location of Vehicle*Have third vehicle?YesNoVEHICLE #3 INFORMATIONRegistered Name for Vehicle*Type:*Personal NameCompany NameYear*Make*Model*Body Type*Please Select One2-DoorConvertible4-DoorStation WagonPickupVanOtherIf Other, Please Specify:*Date of Vehicle Purchase*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920VIN #:*Weight of Vehicle*More than 4500kgLess than 4500kgList Price New*Is Vehicle:*OwnedLeasedAny Business in U.S.?*YesNoPercentage of use in U.S.*Please Describe Main Usage for Vehicle*Liability Limit*Please select one$1,000,000$2,000,000Collision Deductible*Please Select One$300$500$1,000$2,500$5,000Comprehensive Deductible*Please Select One$300$500$1,000$2,000$5,000Loss of Use:*YesNoLimited WaiverThe intentional relinquishment of a known right. A waiver under a policy is required to be clearly expressed and in writing. More of DepreciationReduction in value of property through use, ageing, deterioration and obsolescence. More*YesNoLegal LiabilityLiability imposed by law on individuals or corporations to pay for harm done to others. Such law may be the common law, statute law or customs which o... More For Non-Owned Vehicles*YesNo List Machinery & Equipment:Description:*Year Manufactured*Value:*Description:Year ManufacturedValue:Description:Year ManufacturedValue:Haul any trailers?*YesNoUse of TrailerTrailer TypeTrailer YearTrailer MakeTrailer ModelTrailer ValuePlease list the merchandise carried:Are goods carried for compensation?*YesNoIf yes, is there a contract in place?*YesNoHauling for others?*NeverDailyWeeklyIf yes, is there a contract in place?*YesNo Radius of Operations:Normal Radius: Distance one way (kms):*% of total trips:*Maximum Radius: Distance one way (kms):*% of total trips:*Number of trips per month outside of radius:*Destinations Travelled to: (Cities, Provinces)*Garaged Location of Vehicle* DRIVER #1 INFORMATIONName First Last AgeGenderMaleFemalePrefer Not to AnswerDrives Which Vehicle?Please select all that apply. Vehicle #1 Vehicle #2 Vehicle #3 Percentage of use of this vehicle:How long licensed?Previous Commercial ExperiencePlease Select OneNone1 Year2 Years3 Years4 Years5 Years6 YearsMore than 6 YearsNumber of years experienced driving listed vehicle or similar type of vehicleDrivers License No.License ExpiryEnd of the policy period. More Date YYYY MM DD License Dates: All fields below are required. If not applicable, please indicate N/A. G (yyyy/mm)G1 (yyyy/mm)G2 (yyyy/mm)A (yyyy/mm)AZ (yyyy/mm)Other Class Type & Date (yyyy/mm)Approved Driver's TrainingYesNoConsecutively insuredThe entity (individual or otherwise) whose risk of financial loss from an insured peril is protected by the insurance policy. More for:Please Select OneNone1 Year2 Years3 Years4 Years5 Years6 Years7+ YearsMinor Convictions in the past 3 years:YesNoIf yes, provide dates and types:Major Violations in the past 3 years:YesNoIf yes, provide dates and types:Claims in the past 3 years:YesNoIf yes, provide details on all claims (collision, comprehensive and glass claims):License Suspension in the past 6 years:YesNoIf yes, provide details why your license was suspended, date of the suspension and date of reinstatementThe reactivation of suspended or cancelled insurance. More:Cancellations for Non-Payment in the past 6 years:YesNoIf yes, provide details when cancelled and dates:Add second driver?YesNoDRIVER #2 INFORMATIONName First Last AgeGenderMaleFemalePrefer Not to AnswerDrives Which Vehicle?Please select all that apply. Vehicle #1 Vehicle #2 Vehicle #3 Percentage of use of this vehicle:How long licensed?Previous Commercial ExperiencePlease Select OneNone1 Year2 Years3 Years4 Years5 Years6 YearsMore than 6 YearsNumber of years experienced driving listed vehicle or similar type of vehicleDrivers License No.License ExpiryEnd of the policy period. More Date YYYY MM DD License Dates: All fields below are required. If not applicable, please indicate N/A. G (yyyy/mm)G1 (yyyy/mm)G2 (yyyy/mm)A (yyyy/mm)AZ (yyyy/mm)Other Class Type & Date (yyyy/mm)Approved Driver's TrainingYesNoConsecutively insuredThe entity (individual or otherwise) whose risk of financial loss from an insured peril is protected by the insurance policy. More for:Please Select OneNone1 Year2 Years3 Years4 Years5 Years6 Years7+ YearsMinor Convictions in the past 3 years:YesNoIf yes, provide dates and types:Major Violations in the past 3 years:YesNoIf yes, provide dates and types:Claims in the past 3 years:YesNoIf yes, provide details on all claims (collision, comprehensive and glass claims):License Suspension in the past 6 years:YesNoIf yes, provide details why your license was suspended, date of the suspension and date of reinstatementThe reactivation of suspended or cancelled insurance. More:Cancellations for Non-Payment in the past 6 years:YesNoIf yes, provide details when cancelled and dates:Add Third Driver?YesNoDRIVER #3 INFORMATIONName First Last AgeGenderMaleFemalePrefer Not to AnswerDrives Which Vehicle?Please select all that apply. Vehicle #1 Vehicle #2 Vehicle #3 Percentage of use of this vehicle:How long licensed?Previous Commercial ExperiencePlease Select OneNone1 Year2 Years3 Years4 Years5 Years6 YearsMore than 6 YearsNumber of years experienced driving listed vehicle or similar type of vehicleDrivers License No.License ExpiryEnd of the policy period. More Date YYYY MM DD License Dates: All fields below are required. If not applicable, please indicate N/A. G (yyyy/mm)G1 (yyyy/mm)G2 (yyyy/mm)A (yyyy/mm)AZ (yyyy/mm)Other Class Type & Date (yyyy/mm)Approved Driver's TrainingYesNoConsecutively insuredThe entity (individual or otherwise) whose risk of financial loss from an insured peril is protected by the insurance policy. More for:Please Select OneNone1 Year2 Years3 Years4 Years5 Years6 Years7+ YearsMinor Convictions in the past 3 years:YesNoIf yes, provide dates and types:Major Convictions in the past 3 years:YesNoIf yes, provide dates and types:Claims in the past 3 years:YesNoIf yes, provide details on all claims (collision, comprehensive and glass claims):License Suspension in the past 6 years:YesNoIf yes, provide details why your license was suspended, date of the suspension and date of reinstatementThe reactivation of suspended or cancelled insurance. More:Cancellations for Non-Payment in the past 6 years:YesNoIf yes, provide details when cancelled and dates:Additional Comments/InformationWhich Office Would You Like to Submit this Quote to?*Select your officeAgincourtAjaxAncasterBarrieBramptonBurlingtonClairvilleCliffsideDanforthEssexEtobicokeGeorgetownGreater NapaneeGrimsbyHamiltonCampbellvilleCathedral TownKingstonLeamingtonMarkhamMiltonNewmarketNiagara FallsOakvilleOttawaPelmo ParkPickeringRenfrewRichmond HillSault Ste. MarieStoney CreekStreetsvilleSudburyTecumsehVictoria ParkWaterlooWillowdaleWindsorBoltonCallanderErin MillsHighland CreekKitchenerMaritimeNepeanOrleansPearsonUnionvilleVaughanWoodbridgeLondon SouthPort CreditRouge ValleyCommentsThis field is for validation purposes and should be left unchanged.
