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Get a Quote on Your Car or Truck

With Meadowvale Insurance Brokers Ltd., it’s always easy to get a free quote on your automobile. Simply fill in the form on this page and one of our registered brokers will contact you, usually by the next business day.

Personal Information

First Name:*

Last Name:*

Address:*

City:*

Province (Ontario Residents Only):

Postal Code:*

Home Phone:*

Work Phone:*

Ext.:

Email:*

Do you currently have a policy through Meadowvale Insurance Brokers Ltd?*

Do you currently have an auto insurance policy?*

If yes, please write the date it is set to expire:

Number of years of consecutive insurance:*

Have you ever had your automobile insurance cancelled or refused?*

Do you currently have property insurance?*

Driver Information

Name:

Age:

Years Licensed:

Licence Class:

Sex:

Marital Status:

Driver Training:

Minor Traffic Conviction:

Major Traffic Conviction:

Licence Suspension:

Previous Claim:

Claims Information #1

Type of Claim:

Date of Claim:

Driver Involved:

Claims Information #2

Type of Claim:

Date of Claim:

Driver Involved:

Claims Information #3

Type of Claim:

Date of Claim:

Driver Involved:

Vehicle Information #1

Year:

Make:

Model:

Style:

Annual Kilometres:

Primary Driver:

Use:

Liability Limit:

Collision Deductible:

Comprehensive Deductible:

Loss of Use Coverage:

Waiver of Depreciation:

Vehicle Information #2

Year:

Make:

Model:

Style:

Annual Kilometres:

Primary Driver:

Use:

Liability Limit:

Collision Deductible:

Comprehensive Deductible:

Loss of Use Coverage:

Waiver of Depreciation:

Comments:

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