Commercial Vehicle Quote

Please complete this form as accurately as possible in order to ensure the best possible estimate. If you would rather speak to a sales representative, please call us at 416-728-6806.

Personal Information
Name * First Last
Business Name
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Email
Phone * - (###) - ### ####
Insurance Information
Currently Insured *

Reply Yes or No
If yes, list carrier and number of years of continuous coverage
Type of Business

Please be specific and state how the vehicles are used.
Driver Information

If there is more than 1 driver, please list in comments at the end of this section.
Name
Date of Birth / MM / DD YYYY
Sex M F
Number of years licensed in Canada
Number and type of accidents within last 6 years:
Number and type of traffic violations within the last 3 years:
Have you ever been charged with impaired or careless driving? Yes No
Estimated Annual Driving Distance in Km
Usual Operating Radius (in km)
Other Comments/Remarks

If there are more than one drivers, please state detailed information here using the above as a template.
Commercial Vehicle Information

If there are more than one vehicle, please list them in the comments
Year of Vehicle
Make and Model
Vehicle Type
Vehicle used in Business Yes No
Particulars of the Merchandise Carried
Gross Vehicle Weight (Trucks only)
Purchase Price *
List Price of vehicle
List special equipment & their values (eg- rack, tool box, etc.)
Vehicle VIN Number (highly recomended for accurate rating)
Vehicle Coverage Information
Limits of Liability $1 Million $2 Million $5 Million
Comprehensive, Fire & Theft and Collision Deductible No coverage $500 Deductible $1000 Deductible $2500 Deductible
Do you want increased income replacement coverage? Yes No
Other optional replacement coverage? (Please discuss with me) Yes No
Any other comments/remarks
The completion of this form is for quote purposes and does not provide any insurance coverage. We may require more information about your business to provide a quote. * I agree

Commercial Vehicle Quote

Commercial Vehicle Quote

Personal Information

Insurance Information

Driver Information

Commercial Vehicle Information

Vehicle Coverage Information