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Fill out the following form
Name
Last name
Email
Phone
Date of birth
Full address
Choose between the following options
VIN
What is the year, make, and model of the vehicle?
Is it a lease or a financed purchase?
How many kilometers do you drive with your vehicle each year?
Do you have a tracking or marking system installed on your vehicle?
Renewal date
How much are you currently paying with your current insurer?
How long have you had your driver's license?
Marital Status
Have you made any claims in the past 6 years?
Any tickets or violations in the past 3 years?
Avez-vous eu une suspension de permis au cours des 6 dernières années ?
Are you the sole driver of the vehicle?
Are you the owner, co-owner, or tenant?
Type of property
Construction year
What type of heating system do you use?
Is there a pool, a spa, or an outdoor fireplace?
Is the house equipped with an alarm or surveillance system?
Do you have a connected water or fire detection system?
Do you or anyone living in the same household have a criminal record or court record (plumitif)?
Do you authorize insurance companies to check your credit report with credit agencies as well as your claims history?
Yes
I accept the terms and conditions
Submit
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