Auto Insurance

Car, truck, van motorcycle? We have coverage that’s right for you. Whether you have multiple drivers, vehicles or just one, we can help you find the best price and coverage to protect both you and your car in the event that you do get into an accident.

Start Your Quote

To get a quote, simply fill out the form below and click “Submit.” One of our agents will contact you within one business day to help you select the best car insurance for your vehicle. For other questions, please feel free to contact us.

Applicant Information

Name (required)

Address (required)

City (required)

Postal Code (required)

Home Phone (required)

Mobile Phone (required)

Email (required)

Occupation

Employer

How did you hear about our office?

Vehicle Information

Year Make Model & Trim VIN Purchase Date Renewal Date Current Premium
1
2
3
4
KM to Work Annual KM Coverages (Collision/Comprehensive/Full Winter Tires? Principal Driver
1 YesNo
2 YesNo
3 YesNo
4 YesNo

Have you ever been cancelled for non pay?
YesNo

If yes, when and why?

Other Comments

Driver Information

Please fill out all that apply and the leave the rest blank.

Driver 1

Full Name on License

Drivers License Number or Date of Birth

Relationship

How Long Insured

G1 Date (mm/yy)

G2 Date (mm/yy)

G Date (mm/yy)

Number of Tickets

Number of Accidents

Driver Training & When

Good Student (80%)

Ticket and Accident Detail With Dates

Driver 2

Full Name on License

Drivers License Number or Date of Birth

Relationship

How Long Insured

G1 Date (mm/yy)

G2 Date (mm/yy)

G Date (mm/yy)

Number of Tickets

Number of Accidents

Driver Training & When

Good Student (80%)

Ticket and Accident Detail With Dates

Driver 3

Full Name on License

Drivers License Number or Date of Birth

Relationship

How Long Insured

G1 Date (mm/yy)

G2 Date (mm/yy)

G Date (mm/yy)

Number of Tickets

Number of Accidents

Driver Training & When

Good Student (80%)

Ticket and Accident Detail With Dates

Driver 4

Full Name on License

Drivers License Number or Date of Birth

Relationship

How Long Insured

G1 Date (mm/yy)

G2 Date (mm/yy)

G Date (mm/yy)

Number of Tickets

Number of Accidents

Driver Training & When

Good Student (80%)

Ticket and Accident Detail With Dates

Need Assistance? Call

905-793-3535

Phone

Our Office

2131 Williams Parkway East Unit 1
Brampton, ON L6S 5Z4