General Quote Request

Please complete the following form and one of our licensed insurance brokers will contact you as soon as possible. If you need immediate assistance, please contact us at (705) 549-7437. Our regular business hours are from 8:30 am to 5:00 pm Monday through Friday.

First Name*

Last Name*

E-mail:*

Phone:*

Area Code

Phone Number

Quote Request

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Auto

Commercial

Farm

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Quote Request Forms

If you have a good understanding of your insurance needs please complete one of our quote forms and one of your licensed insurance brokers will get back to you with a detailed quote.

Other Quotes

For Commercial and other insurance quotes please contact our office.

(705) 549-7437, quotes@asselininsurance.com

Motorcycle Quote

Name:*

First

Last

Address:*

Street Address City Province Postal Code

Phone:*

Area Code

Phone Number

E-mail:*

1/5

Make*

Model*

Year*

Purchase Price*

VIN #

2/5

Date of birth*

day

month

year

License Type*

M1 Date

day

month

year

M2 Date

day

month

year

M Date

day

month

year

Drivers License #

Consent to check history

# yrs motorcycle licensed*

Consequetive yrs of insurance*

Vehicle Use*

Driver Training*

# accidents last 6 years*

# convictions last 3 years*

3/5

Liability*

Collision*

Comp*

4/5

Would you like us to quote your home or auto? Additional discounts may apply.*

Additional Information

Recaptcha Word Verification:

5/5

Auto Quote

Name*

First

Last

E-mail:*

Phone:*

Area Code

Phone Number

Address:*

Street Address City Province Postal Code

1/8

Year*

Make*

Model*

VIN #

Purchased*

Purchase price ($)*

Purchase date*

day

month

year

Ownership*

Vehicle Use*

Distance to work / school in km (one way)*

Total business km (if any)

Total estimated km per year*

2/8

Do you need to add another vehicle?

Year(1)*

Make(1)*

Model(1)*

VIN #(1)

Purchased(1)*

Purchase price ($).*

Purchase date(1)*

day

month

year

Ownership(1)*

Vehicle Use(1)*

Distance to work / school in km (one way)(1)*

Total business km (if any)(1)

Total estimated km per year(1)*

3/8

Principal Driver*

First

Last

Marital Status*

License #

Consent to check history

Do you have a full G License*

Graduated Licensing*

Drivers training*

Date completed

day

month

year

Date of birth*

day

month

year

G license*

day

month

year

G1 license*

day

month

year

G2 license*

day

month

year

# at fault accidents past 6 years*

# yrs continuously insured*

Suspension date*

day

month

year

# Convictions past 3 years*

Any license suspensions last 6 years?*

Reason for the suspension*

Suspension duration*

Has an insurer cancelled auto insurance in past 3 years?*

# yrs with current insurer*

Expiry date of current policy or date insurance is required*

4/8

Do you need to add another driver?

Driver #2

First

Last

Marital Status.*

License-#

Do you have a full G License.*

Graduated Licensing.*

Consent to check history.

Drivers training.

Date completed.

day

month

year

Date of birth.*

day

month

year

# yrs continuously insured.

G license.*

day

month

year

G1 license.*

day

month

year

G2 license.*

day

month

year

# Convictions past 3 years.*

# at fault accidents past 6 years.*

Any license suspensions last 6 years?.*

Reason for the suspension.*

Suspension date.*

day

month

year

Suspension duration.*

Has an insurer cancelled auto insurance in past 3 years?.*

5/8

Liability*

Collision*

Comprehensive*

Loss of use

Accident Waiver

Other Coverages

Do you have winter tires

Are you retired

6/8

Did you add a 2nd Vehicles to the quote?

Same coverages for vehicle #2?

Liability(1)*

Collision(1)*

Comprehensive(1)*

Loss of use(1)

Accident Waiver(1)

Other Coverages(1)

Do you have winter tires(1)

Are you retired(1)

7/8

Additional Information

Monthly pay plan (1.3% fee)

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8/8

Homeowners Quote

Name:*

First

Last

Phone*

Area Code

Phone Number

E-mail:*

Smoker*

Date of birth*

day

month

year

First time buyer*

Mortgage*

1/6

Risk Address:*

Street Address City Province Postal / Zip Code

Occupied since*

day

month

year

Meters to fire hydrant*

km to fire hall*

Year built*

Total above ground square footage*

# of stories*

# of families*

# of units*

Structure type*

Style*

Physical shape*

Construction type*

Construction quality*

Primary exterior siding*

Sprinkler System

# detached structures

2/6

Attached carport*

Carport sq/ft

Roof*

Age of roof*

# full baths*

# 1/2 baths*

Basement type*

Garage type*

# of cars

Porch type*

Porch sq/ft

Total deck sq/ft*

Swimming pool*

Hot tub*

Solar Panels

Burglary alarm

Smoke alarm*

# of detectors*

Septic system*

sump pit/pump*

3/6

Electrical wiring*

Electrical service*

Electrical panel*

Year installed*

Plumbing type*

Most recent plumbing update year*

Water heater age*

Primary Heating*

Year installed.*

Auxillary heating*

Oil tank*

Oil tank year

4/6

Personal Liability*

Deductible*

Sewer Backup*

Overland water*

Coverage for high valued jewellery, artwork, etc.*

# yrs continously insured*

Current insurer*

# yrs with current insurer*

Expiry date of current policy or date insurance is required*

Any policy cancelled for non-pay past 3 yrs*

Any claims past 5 yrs*

5/6

Consent to check credit (additional discounts may apply)*

Monthly pay plan*

Additional Information

reCAPTCHA

6/6

Watercraft Quote

Name:*

First

Last

Date of birth:*

day

month

year

Address:*

Street Address City Province Postal Code

Phone:*

Area Code

Phone Number

E-mail:*

1/5

Watercraft type:*

Make:*

Model:*

Year:*

Boat & motor value:*

Trailer value:

Hull type:*

Haul length (ft):*

Engine type:*

Engine hp:*

Top Speed (MPH)*

Engine fuel:*

Engine make:*

Engine year:*

2/5

Yrs experience as boat owner:*

Yrs experience with similar vessel:*

Pleasure craft operator card*

Training:

Currently insured:*

Prior insurance*

Clear driving record:*

Any claims last 3 years:*

Drivers license suspension in the last 3 yrs*

Policy cancelled by insurer:*

3/5

Deductible:*

Liability amount*

Do you require coverage for any special accessories:*

4/5

Additional details:

Recaptcha Word Verification:

5/5

Snowmobile Quote

Name:*

First

Last

Address:*

Street Address City Province Postal Code

Phone:*

Area Code

Phone Number

E-mail:*

1/4

Make*

Model*

Year*

# cc's*

Value*

2/4

Liability*

Collision*

Comp*

3/4

Would you like us to quote your auto? Additional discounts may apply.*

Additional Information

Recaptcha Word Verification:

4/4

Tenants Quote

Name:*

First

Last

Phone*

Area Code

Phone Number

E-mail:*

Smoker*

Date of birth*

day

month

year

1/6

Risk Address:*

Street Address City Province Postal / Zip Code

Occupied since*

day

month

year

Meters to fire hydrant*

km to fire hall*

Year built*

Unit square footage*

# of families*

Structure type*

Construction type*

Primary exterior siding*

Sprinkler System

# detached structures

2/6

Roof*

Age of roof*

# full baths*

# 1/2 baths*

Garage type*

# of cars

Swimming pool*

Hot tub*

Burglary alarm

Smoke alarm*

# of detectors*

Septic system*

sump pit/pump*

3/6

Electrical wiring*

Electrical service*

Electrical panel*

Year installed*

Plumbing type*

Most recent plumbing update year*

Water heater age*

Primary Heating*

Year installed.*

Auxillary heating*

4/6

Personal Liability*

Contents Limit*

Deductible*

Sewer Backup*

Overland water*

Coverage for high valued jewellery, artwork, etc.*

# yrs continously insured*

Current insurer*

# yrs with current insurer*

Expiry date of current policy or date insurance is required*

Any policy cancelled for non-pay past 3 yrs*

Any claims past 5 yrs*

5/6

Consent to check credit (additional discounts may apply)*

Monthly pay plan*

Additional Information

reCAPTCHA

6/6