Automobile Quick Quote Form
To be completed for a quick quote on automobile insurance.
Client Name & Complete Address?
Date of Birth?
How many claims in last 5 years?
How many driving infractions have you had in the last 5 years?
What is your Drivers license number & issuing province?
What year did you get your license?
Have you completed driver training?
Year/Make/Model & Vin Number of Vehicle(s)
Please check what coverage you want quoted?
Collision coverage (Coverage for damage to you're vehicle)
Comprehensive coverage (Fire & Theft)
Comprehensive with Limited Glass (Cheaper Comprehensive waive coverage for glass damage)
What limit of Auto Liability do you want? This is the amount of coverage you have when being sued, if not sufficient it comes from your personal assets!
What deductible would you prefer? Higher the deductible the lower the premiums.
Please list best way to contact you with the estimated premium.
Send me a copy of my responses.
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