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?* Yes No Date* 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* 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? Yes No If yes, state reason and date:* VEHICLE #1 INFORMATIONRegistered Name for Vehicle* Type:* Personal Name Company Name Year*Make* Model* Body Type*Please Select One2-DoorConvertible4-DoorStation WagonPickupVanOtherIf Other, Please Specify:* Date of Vehicle Purchase*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920VIN #:* Weight of Vehicle* More than 4500kg Less than 4500kg List Price New* Is Vehicle:* Owned Leased Any Business in U.S.?* Yes No Percentage 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:* Yes No Limited 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* Yes No Legal 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* Yes No List Machinery & Equipment:Description* Year Manufactured*Value* Description: Year ManufacturedValue: Description: Year ManufacturedValue: Haul any trailers?* Yes No Use of Trailer Trailer Type Trailer YearTrailer Make Trailer Model Trailer Value Please list the merchandise carried:Are goods carried for compensation?* Yes No If yes, is there a contract in place?* Yes No Hauling for others?* Never Daily Weekly If yes, is there a contract in place?* Yes No 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? Yes No VEHICLE #2 INFORMATIONRegistered Name for Vehicle* Type:* Personal Name Company Name Year*Make* Model* Body Type*Please Select One2-DoorConvertible4-DoorStation WagonPickupVanOtherIf Other, Please Specify:* Date of Vehicle Purchase*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920VIN #:* Weight of Vehicle* More than 4500kg Less than 4500kg List Price New:* Is Vehicle:* Owned Leased Any Business in U.S.?* Yes No Percentage 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:* Yes No Limited 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* Yes No Legal 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* Yes No List Machinery & Equipment:Description:* Year Manufactured*Value:* Description: Year ManufacturedValue: Description: Year ManufacturedValue: Haul any trailers?* Yes No Use of Trailer Trailer Type Trailer YearTrailer Make Trailer Model Trailer Value Please list the merchandise carried:Are goods carried for compensation?* Yes No If yes, is there a contract in place?* Yes No Hauling for others?* Never Daily Weekly If yes, is there a contract in place?* Yes No 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? Yes No VEHICLE #3 INFORMATIONRegistered Name for Vehicle* Type:* Personal Name Company Name Year*Make* Model* Body Type*Please Select One2-DoorConvertible4-DoorStation WagonPickupVanOtherIf Other, Please Specify:* Date of Vehicle Purchase*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920VIN #:* Weight of Vehicle* More than 4500kg Less than 4500kg List Price New* Is Vehicle:* Owned Leased Any Business in U.S.?* Yes No Percentage 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:* Yes No Limited 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* Yes No Legal 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* Yes No List Machinery & Equipment:Description:* Year Manufactured*Value:* Description: Year ManufacturedValue: Description: Year ManufacturedValue: Haul any trailers?* Yes No Use of Trailer Trailer Type Trailer YearTrailer Make Trailer Model Trailer Value Please list the merchandise carried:Are goods carried for compensation?* Yes No If yes, is there a contract in place?* Yes No Hauling for others?* Never Daily Weekly If yes, is there a contract in place?* Yes No 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 AgeGender Male Female Prefer Not to Answer Drives 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 Year Month Day 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 Training Yes No Consecutively 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: Yes No If yes, provide dates and types:Major Violations in the past 3 years: Yes No If yes, provide dates and types:Claims in the past 3 years: Yes No If yes, provide details on all claims (collision, comprehensive and glass claims):License Suspension in the past 6 years: Yes No If 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: Yes No If yes, provide details when cancelled and dates:Add second driver? Yes No DRIVER #2 INFORMATIONName First Last AgeGender Male Female Prefer Not to Answer Drives 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 Year Month Day 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 Training Yes No Consecutively 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: Yes No If yes, provide dates and types:Major Violations in the past 3 years: Yes No If yes, provide dates and types:Claims in the past 3 years: Yes No If yes, provide details on all claims (collision, comprehensive and glass claims):License Suspension in the past 6 years: Yes No If 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: Yes No If yes, provide details when cancelled and dates:Add Third Driver? Yes No DRIVER #3 INFORMATIONName First Last AgeGender Male Female Prefer Not to Answer Drives 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 Year Month Day 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 Training Yes No Consecutively 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: Yes No If yes, provide dates and types:Major Convictions in the past 3 years: Yes No If yes, provide dates and types:Claims in the past 3 years: Yes No If yes, provide details on all claims (collision, comprehensive and glass claims):License Suspension in the past 6 years: Yes No If 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: Yes No If yes, provide details when cancelled and dates:Additional Comments/InformationWhich Office Would You Like to Submit this Quote to?*Select your officeAgincourtAjaxAncasterBarrieBramptonBurlingtonClairvilleDanforthEssexEtobicokeGeorgetownGrimsbyHamiltonBurlington NorthCathedral TownKingstonLeamingtonMarkhamMiltonNewmarketNiagara FallsOakvillePelmo ParkPickeringRenfrewRichmond HillSault Ste. MarieStoney CreekStreetsvilleSudburyTecumsehVictoria ParkWaterlooWhitbyWindsorNobletonNobletonBoltonButtonvilleCallanderErin MillsHighland CreekIslingtonKitchenerLondon EastMaritimeMeadowvaleNepeanNobletonNorth YorkOrleansPearsonNobletonUnionvilleVaughanWoodbridgeLondon SouthRouge ValleyPhoneThis field is for validation purposes and should be left unchanged.
