CALL US TODAY! 905-826-5122 Home General Auto Personal Commercial Quotes Contact Us Get a Quote on Your Car or Truck With Meadowvale Insurance Brokers Ltd., it’s always easy to get a free quote on your automobile. Simply fill in the form on this page and one of our registered brokers will contact you, usually by the next business day. Personal Information First Name:* Last Name:* Address:* City:* Province (Ontario Residents Only): Postal Code:* Home Phone:* Work Phone:* Ext.: Email:* Do you currently have a policy through Meadowvale Insurance Brokers Ltd?* Yes No Do you currently have an auto insurance policy?* Yes No If yes, please write the date it is set to expire: Number of years of consecutive insurance:* Have you ever had your automobile insurance cancelled or refused?* Yes No Do you currently have property insurance?* Yes No Driver Information Name: Age: Years Licensed: Licence Class: Sex: Male Female Marital Status: Married Single Driver Training: Yes No Minor Traffic Conviction: None One Two Three Four Five or More Major Traffic Conviction: None One Two Three or More Licence Suspension: Yes No Previous Claim: Yes No Claims Information #1 Type of Claim: At-Fault Not At-Fault Theft Vandalism Windshield Date of Claim: Driver Involved: Driver #1 Driver #2 Driver #3 Claims Information #2 Type of Claim: At-Fault Not At-Fault Theft Vandalism Windshield Date of Claim: Driver Involved: Driver #1 Driver #2 Driver #3 Claims Information #3 Type of Claim: At-Fault Not At-Fault Theft Vandalism Windshield Date of Claim: Driver Involved: Driver #1 Driver #2 Driver #3 Vehicle Information #1 Year: Make: Model: Style: Two Door Two Door Hatch Four Door Four Door Hatch Station Wagon Sports Utility Pick-Up Truck Van Annual Kilometres: Primary Driver: Driver #1 Driver #2 Driver #3 Use: Pleasure Only Commute &gt; 5km Commute 5 - 24km Commute Over 25km Business Use Liability Limit: $1,000,000 $2,000,000 Collision Deductible: No Deductible $300 $500 $1,000 Comprehensive Deductible: No Deductible $300 $500 $1,000 Loss of Use Coverage: Yes No Waiver of Depreciation: Yes No Vehicle Information #2 Year: Make: Model: Style: Two Door Two Door Hatch Four Door Four Door Hatch Station Wagon Sports Utility Pick-Up Truck Van Annual Kilometres: Primary Driver: Driver #1 Driver #2 Driver #3 Use: Pleasure Only Commute &gt; 5km Commute 5 - 24km Commute Over 25km Business Use Liability Limit: $1,000,000 $2,000,000 Collision Deductible: No Deductible $300 $500 $1,000 Comprehensive Deductible: No Deductible $300 $500 $1,000 Loss of Use Coverage: Yes No Waiver of Depreciation: Yes No Comments: Copyright Meadowvale Insurance Brokers Ltd. 2021 - Legal Created by