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Location
- Calgary
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Insurance
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About Us

Hi. How can I help you?

Personal Insurance
Commercial Insurance

Name *

First

Last

Email *

Phone *

What type of Personal Insurance?

Auto
Property

Street Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

How many vehicles? *

1 vehicle
2 vehicle
3 vehicle
4 vehicle

Commercial Auto Form

Owner's information

Owner's name *

Owner's email *

Owner's Phone

First vehicle

Vehicle info

Year

Make

Model

Is your vehicle Financed or Lease? *

Yes
No

Please tell us when this policy will start? *

Winter Tires? *

Yes
No

Where does this vehicle park? *

Private garage
Private driveway
Underground parking
Parking lot
Carport
Indoor storage
Street parking
other

Primary use of vehicle *

Personal
Business
Both Personal and Business

Coverage Options *

One way
Two way

Second vehicle

Vehicle info

Year

Make

Model

Is your vehicle Financed or Lease? *

Yes
No

Winter Tires? *

Yes
No

Where does this vehicle park? *

Private garage
Private driveway
Underground parking
Parking lot
Carport
Indoor storage
Street parking
other

Primary use of vehicle *

Personal
Business
Both Personal and Business

Coverage Options *

One way
Two way

Third vehicle

Vehicle info

Year

Make

Model

Is your vehicle Financed or Lease? *

Yes
No

Winter Tires? *

Yes
No

Where does this vehicle park? *

Private garage
Private driveway
Underground parking
Parking lot
Carport
Indoor storage
Street parking
other

Primary use of vehicle *

Personal
Business
Both Personal and Business

Coverage Options *

One way
Two way

Forth vehicle

Vehicle info

Year

Make

Model

Is your vehicle Financed or Lease? *

Yes
No

Winter Tires? *

Yes
No

Where does this vehicle park? *

Private garage
Private driveway
Underground parking
Parking lot
Carport
Indoor storage
Street parking
other

Primary use of vehicle *

Personal
Business
Both Personal and Business

Coverage Options *

One way
Two way

How many drivers? *

1 driver
2 drivers
3 drivers
4 drivers

1st Driver

Driver's info

1st Driver Name *

First

Last

Birthdate *//

Driver License number *

At what age was your full license issued *

Phone Number

Please select all that applies *

Insurance cancellation in last 3 years
License suspension in last 6 years
At fault claims in last 5 years
Violation tickets in last 3 years
no claims and violations

2nd Driver

Driver's info

2nd Driver Name *

First

Last

Birthdate *//

Driver License number *

At what age was your full license issued *

Phone Number

Please select all that applies *

Insurance cancellation in last 3 years
License suspension in last 6 years
At fault claims in last 5 years
Violation tickets in last 3 years
no claims and violations

3rd Driver

Driver's info

3rd Driver Name *

First

Last

Birthdate *//

Driver License number *

At what age was your full license issued *

Phone Number

Please select all that applies *

Insurance cancellation in last 3 years
License suspension in last 6 years
At fault claims in last 5 years
Violation tickets in last 3 years
no claims and violations

4th Driver

Driver's info

4th Driver Name *

First

Last

Birthdate *//

Driver License number *

At what age was your full license issued *

Phone Number

Please select all that applies *

Insurance cancellation in last 3 years
License suspension in last 6 years
At fault claims in last 5 years
Violation tickets in last 3 years
no claims and violations

Eldest Occupant

Eldest Occupant *

First

Last

Birthdate *//

Do you own or rent? *

Own - Landlord
Rent - Tenant

Occupation *

Accountant
Nurse
Actuary
Optometrist
Chemist
Orthodontist
Chiropractor
Pharmacist
Computer Science
Physicist
Dentist
Student
Teacher
Geologist
Retired
other

other

When did you purchase this property?

When did you move in?

Do you have a mortgage? *

Yes
No

What are you charging for rent?

Who resides in the residence? *

You
You and your family
Your family and another family
Your family and two another families
It's rented out / commercial purposes

Property Manager Information

Property Manager name *

property manager address *

Address Line 1

City

State / Province / Region

Postal Code

When should we make the effective date?

What is the SQFT? *

How many bathrooms? *

1
1.5
2
2.5
3
3.5
4.5
5+

How many bedrooms? *

1
2
3
4
5
5+

Contents to protect *

min 30k
35k
40k
45k
50k
55k
60k
70k
80k
90k
100k
100k+

When did you move in? *

Do you have a current policy? *

Yes
No

Do you have a current policy? *

Yes
No

How long have you had insurance without gaps? *

0 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
10+

How long have you been with your current Insurance comapny? *

0 year
1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
10+

Claims In the last 5 years? *

Yes
No

Have you ever had home Insurance? *

Yes
No

Claims In the last 5 years? *

Yes
No

Do you pay monthly for monitored security system *

Yes
No

Are the occupants non-smokers? *

Yes
No

Are the occupants non-smokers? *

Yes
No

Property Upgrades Heating

Heating

Year updated

Property Upgrades Plumbing

Plumbing

Year updated

Property Upgrades Hot water tank

Hot water tank

Year updated

Property Upgrades Roof

Roof

Year updated

Property Upgrades Furnace

Furnace

Year updated

Business info

Nature of the business

Usual operating radius *

Maximum radius

Days operation out of Alberta

Value of attached machinery *

Will drivers be making deliveries

Insurance Information

Tansporting dangerous good *

Yes
No

Is there a CGL currently in force *

Yes
No

Has there been a commercial claim in the last 5 years *

Yes
No

Insurance lapse in the last 6 years *

Yes
No

Rented or Leased to others *

Yes
No

Drivers' Information

Do all drivers have 3 years of experience driving these types of vehicles? *

Yes
No

How many drivers? *

1 Driver
2 Drivers
3 Drivers
4 Drivers

1st Driver

Driver's info

1st Driver Name *

First

Last

Birthdate *//

Driver License number *

At what age was your full license issued *

Phone Number

Please select all that applies *

Insurance cancellation in last 3 years
License suspension in last 6 years
At fault claims in last 5 years
Violation tickets in last 3 years
no claims and violations

2nd Drivers

Driver's info

2nd Drivers Name *

First

Last

Birthdate *//

Driver License number *

At what age was your full license issued *

Phone Number

Please select all that applies *

Insurance cancellation in last 3 years
License suspension in last 6 years
At fault claims in last 5 years
Violation tickets in last 3 years
no claims and violations

3rd Drivers

Driver's info

3rd Drivers Name *

First

Last

Birthdate *//

Driver License number *

At what age was your full license issued *

Phone Number

Please select all that applies *

Insurance cancellation in last 3 years
License suspension in last 6 years
At fault claims in last 5 years
Violation tickets in last 3 years
no claims and violations

4th Drivers Name

Driver's info

4th Drivers Name *

First

Last

Birthdate *//

Driver License number *

At what age was your full license issued *

Phone Number

Please select all that applies *

Insurance cancellation in last 3 years
License suspension in last 6 years
At fault claims in last 5 years
Violation tickets in last 3 years
no claims and violations

Vehicle Information *

1 vehicles
2 vehicles
3 vehicles
4 vehicles

1st Vehicle

Years

Make

Model

VIN

% Business use

First Lien holder

Financed *

Yes
No

Leased *

Yes
No

Do you require full coverage *

Yes
No

2nd Vehicle

Years

Make

Model

VIN

% Business use

Second Lien holder

Financed *

Yes
No

Leased *

Yes
No

Do you require full coverage *

Yes
No

3rd Vehicle

Years

Make

Model

VIN

% Business use

Third Lien holder

Financed *

Yes
No

Leased *

Yes
No

Do you require full coverage *

Yes
No

4th Vehicle

Years

Make

Model

VIN

% Business use

Fourth Lien holder

Financed *

Yes
No

Leased *

Yes
No

Do you require full coverage *

Yes
No

Any special requests? Something that we should know to get a more accurate quote? *

Getting insurance can be complicated, and involve a wide range of factors. Getting the right insurance policy can help protect your investments, and save you thousands of dollars. At InsureLine, we understand the complexities of finding the right insurance coverage. We are passionate about ‘Simplifying Insurance’, and saving customers money.

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Commercial Auto Form

Owner's information

First vehicle

Vehicle info

Second vehicle

Vehicle info

Third vehicle

Vehicle info

Forth vehicle

Vehicle info

1st Driver

Driver's info

2nd Driver

Driver's info

3rd Driver

Driver's info

4th Driver

Driver's info

Company information

Eldest Occupant

Property Manager Information

Business info

Insurance Information

Drivers' Information

1st Driver

Driver's info

2nd Drivers

Driver's info

3rd Drivers

Driver's info

4th Drivers Name

Driver's info

1st Vehicle

First Lien holder

2nd Vehicle

Second Lien holder

3rd Vehicle

Third Lien holder

4th Vehicle

Fourth Lien holder

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