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Auto insurance quote with
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2
3
Step 1: Driver Details (for Driver #1)
Driver 1's Name
*
First
Last
Date of birth (MM/DD/YY)
*
MM
DD
YYYY
Gender
*
Male
Female
Marital Status
Single
Married/Common-law
Divorced/Widowed
How many years has this driver held a valid driver's license?
Please choose
Less than 1 year
More than 1 and less than 2 years
More than 2 and less than 3 years
More than 3 and less than 4 years
More than 4 and less than 5 years
More than 5 and less than 6 years
More than 6 and less than 7 years
More than 7 and less than 8 years
More than 8 and less than 9 years
More than 9 and less than 10 years
More than 10 and less than 11 years
More than 11 and less than 12 years
More than 12 and less than 13 years
More than 13 and less than 14 years
More than 14 and less than 15 years
Over 15 years
How many years has this driver been insured as a driver on an insurance policy?
Please choose
Less than 1 year
More than 1 and less than 2 years
More than 2 and less than 3 years
More than 3 and less than 4 years
More than 4 and less than 5 years
More than 5 and less than 6 years
More than 6 and less than 7 years
More than 7 and less than 8 years
More than 8 and less than 9 years
More than 9 and less than 10 years
More than 10 and less than 11 years
More than 11 and less than 12 years
More than 12 and less than 13 years
More than 13 and less than 14 years
More than 14 and less than 15 years
Over 15 years
Please note: Being insured as an occasional or secondary driver does count here.
In the past 6 years, has this driver been considered at-fault for any automobile accidents?
No
Yes
Not sure
In the past 3 years, has this driver had any of the following traffic convictions: Blood Alcohol over .08, Careless Driving, Dangerous Driving?
No
Yes
Not Sure
In the past 3 years, has this driver's insurance policy been suspended or lapsed?
*
No
Yes, due to NSF/non-payment of premiums
Yes, due to other reasons
Would you like to enter details for a 2nd driver on this policy?
No
Yes
Step 1b: Driver Details (for Driver #2)
Driver 2's name
First
Last
Date of birth (MM/DD/YY)
MM
DD
YYYY
Gender
Male
Female
Marital status
Single
Married/Common-law
Divorced
Widowed
What is this driver's occupation?
How many years has this driver held a valid driver's license?
Please choose
Less than 1 year
More than 1 and less than 2 years
More than 2 and less than 3 years
More than 3 and less than 4 years
More than 4 and less than 5 years
More than 5 and less than 6 years
More than 6 and less than 7 years
More than 7 and less than 8 years
More than 8 and less than 9 years
More than 9 and less than 10 years
More than 10 and less than 11 years
More than 11 and less than 12 years
More than 12 and less than 13 years
More than 13 and less than 14 years
More than 14 and less than 15 years
Over 15 years
How many years has this driver been insured as a driver on an insurance policy?
Please choose
Less than 1 year
More than 1 and less than 2 years
More than 2 and less than 3 years
More than 3 and less than 4 years
More than 4 and less than 5 years
More than 5 and less than 6 years
More than 6 and less than 7 years
More than 7 and less than 8 years
More than 8 and less than 9 years
More than 9 and less than 10 years
More than 10 and less than 11 years
More than 11 and less than 12 years
More than 12 and less than 13 years
More than 13 and less than 14 years
More than 14 and less than 15 years
Over 15 years
In the past 6 years, has this driver been considered at-fault for any automobile accidents?
No
Yes
Not sure
In the past 3 years, has this driver had any of the following traffic convictions: Blood Alcohol over .08, Careless Driving, Dangerous Driving?
No
Yes
Not Sure
In the past 3 years, has this driver's insurance policy been suspended or lapsed?
No
Yes, due to NSF / Non-payment of premium
Yes, due to other reasons
Step 2: Vehicle Details (for Vehicle #1)
What year is the vehicle?
*
Older than 1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Please choose
What is the make of the vehicle?
*
Please choose
ACURA
ASTON MARTIN
AUDI
BENTLEY
BMW
BUICK
CADILLAC
CHEVROLET
CHRYSLER
DODGE
FERRARI
FORD
GMC
HONDA
HUMMER
HYUNDAI
INFINITI
JAGUAR
JEEP
KIA
LAMBORGHINI
LAND ROVER
LEXUS
LINCOLN
LOTUS
MASERATI
MAYBACH
MAZDA
MERCEDES
MERCEDES-BENZ
MINI
MITSUBISHI
NISSAN
PONTIAC
PORSCHE
ROLLS-ROYCE
SAAB
SATURN
SMART
SUBARU
SUZUKI
TESLA
TOYOTA
VOLKSWAGEN
VOLVO
Please type the model of the vehicle: (eg. "Civic EX")
*
Please choose the liability coverage for this vehicle:
$1,000,000 (standard)
$2,000,000
More than $2,000,000
Please choose the collision coverage amount:
Do not want collision coverage
$250 deductible
$500 deductible (standard)
$1,000 deductible
Please choose the comprehensive coverage amount:
Do not want comprehensive coverage
$250 deductible (standard)
$500 deductible
$1000 deductible
About how many km is this vehicle driven each day to work or school (one-way)?
No commuting; recreational use only
1 to 5 KM
6 to 10 KM
11 to 15 KM
16 to 20 KM
21 to 25 KM
26 or more KM
About how many km is it driven total each year?
Less than 5,000 km
Between 5,001 and 8,000 km
Between 8,001 and 12,000 km
Between 12,001 and 20,000 km
Between 20,001 and 30,000 km
More than 30,000 KM
About how many business or commercial kms is this vehicle driven for each year?
No business or commercial use at all
Less than 5,000 business/commercial kms
More than 5,000 business/commercial kms
Would you like to enter details for a second vehicle on this policy?
No
Yes
Step 2b: Vehicle Details (for Vehicle #2)
What year is the vehicle?
Older than 1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Please choose
What is the make of the vehicle?
Please choose
ACURA
ASTON MARTIN
AUDI
BENTLEY
BMW
BUICK
CADILLAC
CHEVROLET
CHRYSLER
DODGE
FERRARI
FORD
GMC
HONDA
HUMMER
HYUNDAI
INFINITI
JAGUAR
JEEP
KIA
LAMBORGHINI
LAND ROVER
LEXUS
LINCOLN
LOTUS
MASERATI
MAYBACH
MAZDA
MERCEDES
MERCEDES-BENZ
MINI
MITSUBISHI
NISSAN
PONTIAC
PORSCHE
ROLLS-ROYCE
SAAB
SATURN
SMART
SUBARU
SUZUKI
TESLA
TOYOTA
VOLKSWAGEN
VOLVO
Please type the model of the 2nd vehicle: (eg. "Civic EX")
Please choose the liability coverage for this vehicle:
$1,000,000 (standard)
$2,000,000
More than $2,000,000
Please choose the collision coverage amount:
Do not want collision coverage
$250 deductible
$500 deductible (standard)
$1,000 deductible
Please choose the comprehensive coverage amount:
Do not want comprehensive coverage
$250 deductible (standard)
$500 deductible
$1000 deductible
About how many km is this vehicle driven each day to work or school (one-way)?
No commuting; recreational use only
1 to 5 KM
6 to 10 KM
11 to 15 KM
16 to 20 KM
21 to 25 KM
26 or more KM
About how many km is it driven total each year?
Less than 5,000 km
Between 5,001 and 8,000 km
Between 8,001 and 12,000 km
Between 12,001 and 20,000 km
Between 20,001 and 30,000 km
More than 30,000 KM
About how many business/commercial kms is this vehicle driven for each year?
No business or commercial use at all
Less than 5,000 business/commercial kms
More than 5,000 business/commercial kms
Part 3: Contact Information
* IMPORTANT: This section must be fully and accurately completed in order for our licensed Alberta insurance brokers to provide you with an insurance quote. No information will be shared with any third parties except the licensed broker responsible for completing your insurance quote. Please allow up to 24 business hours for completion of your quote.
Who should we contact regarding this quote?
*
First
Last
Address
*
Street Address
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Home/cell phone number
*
Business/work phone number
Email
*
When would be the best time for a broker to contact you with your insurance quotes?
*
Anytime
Morning (9:00 am to 11:59 am)
Afternoon (12:00 pm to 4:30 pm)
Evening (4:30 pm to 8:00 pm)
By clicking "Get Quotes", I understand that the information from this form will be provided to a licensed insurance broker with Capital Insurance. I also understand that a broker may contact me via phone or email to provide quotes or to obtain additional information needed to provide quotes.
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