Saunders Insurance Ltd.

Auto Quote

Insured Information
Insured Name *
Address
City
Province
Postal Code
Phone
Email *
Current Insurance
Do you presently have Auto Insurance? Yes  No
Company Name
Renewal Date
Annual Premium
Have you been cancelled or non-renewed in the past 3 years? Yes  No
Coverages
Liability Limit
Comprehensive Deductible
Collision Deductible
Rental Reimbursement Yes  No
Licensed Drivers
1. (Primary Driver)
Gender Male  Female
Marital Status Married
Single
Divorced
Widowed
Relationship to Applicant
Occupation
Driver Training Yes  No
Tickets
Past 3 years
Accidents (at fault)
Past 6 years

Name on License
Gender Male  Female
Marital Status Married
Single
Divorced
Widowed
Relation to Applicant
Occupation
Good Student Yes  No
Driver Training Yes  No
Tickets
Past 3 years
Accidents (at fault)
Past 6 years
Other Drivers
Please provide the names and birthdates of any other residents in your household licensed to drive.
  Name
1.
2.
3.
Vehicle(s) Information
1.
Year
Make
Model
VIN (if possible)
Annual Mileage
Is the vehicle driven to work? Yes  No
If yes, how many kilometers (1 way)?
# of Doors
Alarm System Yes  No

Year
Make
Model
VIN (if possible)
Annual Mileage
# of Doors
Alarm System Yes  No
* = Required Field
Disclaimer Notice - The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.

Saunders Insurance
5216 48th Ave.
Taber, AB. T1G-1S1

Local Phone: 403.223.4434

Toll Free: 888.223.4434
Fax: 403.223.1769      
 
Contact Us | Get A Quote | Facebook

Insurance News

News feed is unavailable...