Personal Information Privacy and Electronic Document Act (PIPEDA) Consent
This form collects personal contact information so that we may correspond with you and provide the results of your quotation. It also collects underwriting information about your automobile, personal property, driving record and claims history. This information is required by the insurance company to provide a rate for insurance coverage. It may be submitted to an insurance company for the single purpose of obtaining a quote. I give consent for the information provided in this form to be used by 
and its representatives.
The online quote is presently under construction, however, if you complete the form below with the required fields and push send a registered insurance broker will contact you.
Professional Insurance
Accountants
Directors and Officers
Errors and Omissions
Life Agents
I.T. Professionals