Quotes

Auto Insurance

Please take a few minutes to fill in the basic application below and we will start working to help you find better value for your auto insurance dollars.

Out of respect for your confidentiality, we do not ask for all relevant information over the internet. A Haber Blain Insurance Professional will call you within 1 - 2 business days to discuss your personal needs in slightly more detail in order to give you a comparision quote over the phone.

Name:

Address:

City:

Province:

Postal Code:

(X1Y 2Z3)

Email Address:

(xxx@yyyy.zzz)

Phone Number:

(123-456-7890)

Fax Number:

(123-456-7890)

Preferred contact method:

Email Telephone

Expiry Date of Current Insurance:

Drivers:

	One	Two	Three	Four
Age:
# of years Licenced in ON:
Licence Type

Vehicles:

	One	Two
Year:
Make:
Model:
Collision Deductible:
Comprehensive Deductible:
Vehicle Use:
	Three	Four
Year:
Make:
Model:
Collision Deductible:
Comprehensive Deductible:
Vehicle Use:

Are all Drivers clear of accidents in the last 6 years?

Yes No

Are all Drivers clear of traffic violations (speeding etc)?

Yes No

Your Best Insurance is an Insurance Broker