Auto Insurance Online Quote Request

Auto Insurance Quote Request Form

Your privacy and security are important to us. We will never sell or share your private information with a 3rd party. This form is secure and your information is encrypted during submission.

"*" indicates required fields

Depending on your driving record, completing this form takes as little as 2 minutes. Your request will be reviewed thoroughly by an auto insurance expert to ensure that we can provide you the best coverage at the most affordable price. You will receive a comprehensive quote by email. Our competitors "Instant Online Quotes" are often inaccurate and may fail to offer discounts and other savings that only our insurance experts can obtain for you.

Pre-Requisite Questions

Are you currently a resident of Ontario Canada?*

Yes

Sorry, you must be a resident of Ontario Canada to apply for a quote.

How many vehicles require insurance?*

One

Two

Three +

Sorry, this form can only accept up to two vehicles, We can still provide you a quote - please contact us by phone.

How many drivers will you list?*

One (Applicant is Driver #1)

Two (Referred to as Driver #2)

Three (Referred to as Driver #3)

Four +

Drivers include anyone over the age of 16 that live in the same household who DO NOT have their own auto insurance.

Sorry, this form can only accept up to three drivers. We can still provide you a quote - please contact us by phone.

Applicant (Driver #1)

Name*

First Last

Gender*

Male

Female

Address*

Street Address City Postal Code

Phone*

Email*

Enter Email Confirm Email

Renewal / Start Date*

DD slash MM slash YYYY

What is the renewal date of your current policy or date you wish coverage to start?

Vehicle #1 Information

Year*

Make*

Model*

17 Digit VIN #

Purchase Month*

Purchase Year*

Business Use?*

Do you use your vehicle for business use?

Type of coverage*

KMs to work*

Enter the # of kms this vehicle is driven one-way to work.

KMs yearly?*

Enter the total kms driven yearly.

Winter Tires?*

Vehicle #2 Info

Year*

Make*

Model*

17 Digit VIN #

Purchase Month*

Purchase Year*

Type of coverage*

Business Use?*

Do you use your vehicle for business use?

KMs to work*

Enter the number of kms this vehicle is driven one-way to work.

KMs yearly?*

Enter the total kms driven yearly.

Winter Tires?*

Applicant (Driver #1)

Birth Month*

Birth Day*

Birth Year*

Applicant: Status*

Applicant: Occupation*

Certain occupations are eligible for additional group discounts!

Applicant: Do you own a home or condo?*

We offer additional discounts when you bundle your home and auto insurance.

Licence Dates*

Please provide the dates you received your G1, G2 and/or G license.

Applicant: What 'class' of license do you currently hold?*

Applicant: Driver's License #*

Applicant: Earliest date you obtained your drivers license?*

DD slash MM slash YYYY

Using the calendar, choose a YEAR first and then Month and Day. Guess on day and month if not available. The YEAR is important.

Applicant: Did you take certified driver training?*

Applicant: How many years of CONTINUOUS insurance have you held in the past 20 years?*

Applicant: Current Insurance Status*

Applicant: Why are you un-insured?*

Applicant: Have you ever been licensed outside of the Province?*

Appicant History

Applicant: How many AT FAULT accidents in past 6 years?*

Date Accident #1*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Date Accident #2*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Date Accident #3*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Date Accident #4*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Applicant: How many TICKETS in the past 3 years?*

Date Ticket #1*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #1*

Date Ticket #2*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #2*

Date Ticket #3*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #3*

Date Ticket #4*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #4*

Date Ticket #5*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #5*

Date Ticket #6*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #6*

Date Ticket #7*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #7*

Applicant: In the past 3 years, how many times has your license been suspended for OVER 30 days?*

Reason for Suspension #1*

Date of Suspension #1*

DD slash MM slash YYYY

Date of Reinstatement #1*

DD slash MM slash YYYY

Reason for Suspension #2*

Date of Suspension #2*

DD slash MM slash YYYY

Date of Reinstatement #2*

DD slash MM slash YYYY

Reason for Suspension #3*

Date of Suspension #3*

DD slash MM slash YYYY

Date of Reinstatement #3*

DD slash MM slash YYYY

Applicant: How many times has your policy been cancelled for NON-PAYMENT in the past 3 years?*

Date of 1st Cancellation*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Date of 2nd Cancellation*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Date of 3rd Cancellation*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Applicant: Have you ever been cancelled for NON-DISCLOSURE?*

Applicant: Have you ever been cancelled for MIS-REPRESENTATION?*

Driver #2 Info

Driver #2: Name*

First Last

Driver #2: Gender*

Male

Female

Birth Month*

Birth Day*

Birth Year*

Driver #2: Status*

Driver #2: Occupation*

Certain occupations are eligible for additional group discounts!

Driver #2: Own a home or condo?*

We offer additional discounts when you bundle your home and auto insurance.

Driver #2: Licence Dates*

Please provide the dates you received your G1, G2 and/or G license.

Driver #2: What 'class' of Driver's License do you current hold?*

Driver #2: Earliest date you obtained your drivers license?*

DD slash MM slash YYYY

Guess on day and month if unknown. The YEAR must be exact.

Driver #2: Driver's License #*

Driver #2: Take certified driver training?*

Driver #2 How many years of CONTINUOUS insurance held in the past 20 years?*

Driver #2: Current Insurance Status*

Driver #2: Why un-insured?*

Driver #2: Have you ever been licensed outside of the Province?*

Driver #2 History

Driver #2: How many AT FAULT accidents in past 6 years?*

Date of Accident #1*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Date of Accident #2*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Date of Accident #3*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Date of Accident #4*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Driver #2: How many TICKETS in the past 3 years?*

Date Ticket #1*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #1*

Date Ticket #2*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #2*

Date Ticket #3*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #3*

Date Ticket #4*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #4*

Date Ticket #5*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #5*

Date Ticket #6*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #6*

Date Ticket #7*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #7*

Driver #2: In the past 3 years, how many times has license been suspended for OVER 30 days?*

Reason for Suspension #1*

Date of Suspension #1*

DD slash MM slash YYYY

Date of Reinstatement #1*

DD slash MM slash YYYY

Reason for Suspension #2*

Date of Suspension #2*

DD slash MM slash YYYY

Date of Reinstatement #2*

DD slash MM slash YYYY

Reason for Suspension #3*

Date of Suspension #3*

DD slash MM slash YYYY

Date of Reinstatement #3*

DD slash MM slash YYYY

Driver #2: How many times has policy been cancelled for NON-PAYMENT in the past 3 years?*

Date of 1st Cancellation*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Date of 2nd Cancellation*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Date of 3rd Cancellation*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Driver #2: Ever been cancelled for NON-DISCLOSURE?*

Driver #2: Ever been cancelled for MIS-REPRESENTATION?*

Driver #3 Info

Driver #3: Name*

First Last

Driver #3: Gender*

Male

Female

Birth Month*

Birth Day*

Birth Year*

Driver #3: Status*

Driver #3: Occupation*

Certain occupations are eligible for additional group discounts!

Driver #3: Own a home or condo?*

We offer additional discounts when you bundle your home and auto insurance.

Driver #3: Licence Dates*

Please provide the dates you received your G1, G2 and/or G license.

Driver #3: What 'class' of Driver's License do you current hold?*

Driver #3: Driver's License #*

Driver #3: Earliest date you obtained your drivers license?*

DD slash MM slash YYYY

Guess on day and month if unknown. The YEAR must be exact.

Driver #3: Take certified driver training?*

Driver #3: How many years of CONTINUOUS insurance held in the past 20 years?*

Driver #3: Current Insurance Status*

Driver #3: Why un-insured?*

Driver #3: Have you ever been licensed outside of the Province?*

Driver #3 History

Driver #3: How many AT FAULT accidents in past 6 years?*

Date of Accident #1*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Date of Accident #2*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Date of Accident #3*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Date of Accident #4*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Driver #3: How many TICKETS in the past 3 years?*

Date Ticket #1*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #1*

Date Ticket #2*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #2*

Date Ticket #3*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #3*

Date Ticket #4*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #4*

Date Ticket #5*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #5*

Date Ticket #6*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #6*

Date Ticket #7*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Reason #7*

Driver #3: In the past 3 years, how many times has license been suspended for OVER 30 days?*

Reason for Suspension #1*

Date of Suspension #1*

DD slash MM slash YYYY

Date of Reinstatement #1*

DD slash MM slash YYYY

Reason for Suspension #2*

Date of Suspension #2*

DD slash MM slash YYYY

Date of Reinstatement #2*

DD slash MM slash YYYY

Reason for Suspension #3*

Date of Suspension #3*

DD slash MM slash YYYY

Date of Reinstatement #3*

DD slash MM slash YYYY

Driver #3: How many times has policy been cancelled for NON-PAYMENT in the past 3 years?*

Date of 1st Cancellation*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Date of 2nd Cancellation*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Date of 3rd Cancellation*

DD slash MM slash YYYY

Enter 1st day of the month if unsure of the exact date.

Driver #3: Ever been cancelled for NON-DISCLOSURE?*

Driver #3: Ever been cancelled for MIS-REPRESENTATION?*

Phew ... Final Questions!

How did you hear about us?*

Referral Name*

Please Specify the Employee Group, Friend or Family Member or Specific Broker's name that referred you to us.

What is your preferred contact method?*

Do you have any additional comments or notes you'd like to add to your submission?

Please let us know if you have any additional information or comments.

Consent*

I agree

As your potential broker, we are gathering this consent on behalf of the insurer who advises us that: in respect of this quotation/application, any policy we issue and subsequent renewals or changes, we may collect, use and disclose personal information reports including policy history, claims history, investigative information, rating information, risk information and only with respect to you, your personal credit information including credit score, as permitted by law and in accordance with our privacy policies.

Do you, and on behalf of others listed, authorize us to collect, use and disclose to appropriate third parties, including your broker, this information solely relating to your personal automobile policy for the purposes necessary to assess the risk, determine a premium, determine eligibility and conditions for a premium payment plan, investigate and settle claims, analyze business results and detect and prevent fraud?

CAPTCHA

Auto Insurance Online Quote Request

Auto Insurance Quote Request Form

Pre-Requisite Questions

Sorry, you must be a resident of Ontario Canada to apply for a quote.

Sorry, this form can only accept up to two vehicles, We can still provide you a quote - please contact us by phone.

Sorry, this form can only accept up to three drivers. We can still provide you a quote - please contact us by phone.

Applicant (Driver #1)

Vehicle #1 Information

Vehicle #2 Info

Applicant (Driver #1)

Appicant History

Driver #2 Info

Driver #2 History

Driver #3 Info

Driver #3 History

Phew ... Final Questions!

Save big with StoneRidge Group Home & Auto group discounts on home and automobile insurance.