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1.

What type of vehicle(s) do you own?

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2.

First Name 

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3.

Last Name

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4. What Is Your Date Of Birth?
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5.

Driver Lisence Number

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6.

Policy Start Date 

7.

What is the primary use of the vehicle?

 
 
 
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8.

How many years have you had insurance in Canada or your home country?

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9.

Have you had any at-fault accidents or traffic violations in the past 6 years?

10.

Are you interested in the following service?

Thank you for completing the Car Insurance Needs Assessment Quiz! Your answers will help us tailor a policy to meet your specific needs. Please Call us at 780 862 4985 for prompt assistance. One of our team members will be in touch with you soon.