Auto and Motorcycle Quote Page
Please fill in details below for quote only
Name *
Street address *
Province *	AB BC MB NB NF NT NS NU ON PE QC SK YT
Postal Code *
Phone *
E-Mail *
Contact Method	Email Phone
Do you understand the following will provide a quote and NO coverage is in effect until confirmed by a Guardsman Broker? *	Yes No
Do you understand and agree if the answers are materially inaccurate it may result in your policy not being issued, rated, or a claim may be denied? *	Yes No
How many years have you been insured in Canada / US without interruption? *	None 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33+
Has your insurance been cancelled in the past 3 years for nonpayment? *	Yes No
Who is your current insurer and expiry date? *
Information Required on Vehicle
Help Year *
Vehicle 1 year	2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979
Vehicle 2 year	2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980
Help Make *
Vehicle 1 make	ACURA ALFA ROMEO Other AM GENERAL AMERICAN MOTORS ARROW ASTON MARTIN AUDI AUSTIN AVANTI BEAUMONT BENTLEY BERTONE BITTER BMW BORGWARD BRICKLIN BUICK CADILLAC CHECKER CHEVROLET/GEO CHRYSLER CITROEN COLT DACIA DAEWOO DAIHATSU DAIMLER DATSUN/NISSAN DELOREAN DESOTO DKW DODGE EAGLE EDSEL ENVOY EXCALIBUR FARGO TRUCKS FERRARI FIAT FORD GLAS GMC Harley Davidson HILLMAN HONDA HUDSON HUMBER HYUNDAI INFINITI INNOCENTI INTERNATIONAL ISETTA ISUZU JAGUAR JEEP JENSEN Kawasaki KIA LADA LAMBORGHINI LANCIA LAND ROVER LEXUS LINCOLN LOTUS MANIC MANUFAC MASERATI MAYBACH MAZDA MERCEDES-BENZ MERCURY METEOR MG MINI MITSUBISHI MONARCH MORGAN MORRIS NASH NISSAN NSU OLDSMOBILE OPEL OPTIMA PACKARD PEUGEOT PLYMOUTH PONTIAC PORSCHE PUMA Range Rover RENAULT RILEY ROLLS ROYCE ROVER SAAB SATURN SIMCA SINGER SKODA STERLING SUBARU SUNBEAM SUZUKI TOYOTA TRIUMPH TVR VANGUARD VAUXHALL VOLKSWAGEN VOLVO WILLYS WOLSELEY Yamaha YUGO
Vehicle 2 make	None ACURA ALFA ROMEO Other AM GENERAL AMERICAN MOTORS ARROW ASTON MARTIN AUDI AUSTIN AVANTI BEAUMONT BENTLEY BERTONE BITTER BMW BORGWARD BRICKLIN BUICK 100 CADILLAC CHECKER CHEVROLET/GEO CHRYSLER CITROEN COLT DACIA DAEWOO DAIHATSU DAIMLER DATSUN/NISSAN DELOREAN DESOTO DKW DODGE EAGLE EDSEL ENVOY EXCALIBUR FARGO TRUCKS FERRARI FIAT FORD GLAS GMC Harley Davidson HILLMAN HONDA HUDSON HUMBER HYUNDAI INFINITI INNOCENTI INTERNATIONAL ISETTA ISUZU JAGUAR JEEP JENSEN Kawasaki KIA LADA LAMBORGHINI LANCIA LAND ROVER LEXUS LINCOLN LOTUS MANIC MANUFAC MASERATI MAYBACH MAZDA MERCEDES-BENZ MERCURY METEOR MG MINI MITSUBISHI MONARCH MORGAN MORRIS NASH NISSAN NSU OLDSMOBILE OPEL OPTIMA PACKARD PEUGEOT PLYMOUTH PONTIAC PORSCHE PUMA RENAULT RILEY ROLLS ROYCE Range ROVER ROVER SAAB SATURN SIMCA SINGER SKODA STERLING SUBARU SUNBEAM SUZUKI TOYOTA TRIUMPH TVR VANGUARD VAUXHALL VOLKSWAGEN VOLVO WILLYS WOLSELEY Yamaha YUGO
Help Model *
Vehicle 1 model
Vehicle 2 model
Vehicle Use IMPORTANT HOW FAR DO YOU DRIVE TO WORK ONE WAY *
Vehicle 1 use How far to work 1 way	- Select - Pleasure Business Commute to work
Vehicle 2 use How far to work 1 way	- Select - Pleasure Business Commute to work
Help Annual kilometers
Vehicle 1 annual KM	Please choose Less than 5000 km 5,001-6,000 6,001-7,000 7,001-8,000 8,001-9,000 9,001-10,000 10,001-12,000 12,001-16,000 16,001-20,000 20,001-22,000 22,001-24,000 24,001-26,000 26,001-32,000 More than 32 000 km
Vehicle 2 annual KM	None Less than 5000 km 5,001-6,000 6,001-7,000 7,001-8,000 8,001-9,000 9,001-10,000 10,001-12,000 12,001-16,000 16,001-20,000 20,001-22,000 22,001-24,000 24,001-26,000 26,001-32,000 More than 32 000 km
Driver Information
Name *
Driver 1 Name
Driver 2 Name
Driver 3 Name
Gender *
Driver 1 Gender	M F
Driver 2 Gender	M F
Driver 3 Gender	M F
Date of Birth
Driver 1 DOB	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910
Driver 2 DOB	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910
Driver 3 DOB	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910
License Class *
Driver 1 License Class & date licensed	- Select - G G1 G2 Gm Gz A Az
Driver 2 Licence Class & date licensed	- Select - G G1 G2 Gm Gz A Az
Driver 3 Licence Class & date licensed	- Select - G G1 G2 Gm Gz A Az
Years Licensed in Canada *
Driver 1 Years Licenced	None 1 in Years 2 3 4 5 6 7 8 9 10 Years Plus
Driver 2 Years Licenced	None 1 in Years 2 3 4 5 6 7 8 9 10 Years Plus
Driver 3 Years Licenced	None 1 in Years 2 3 4 5 6 7 8 9 10 Years Plus
Principal Driver *
Driver 1 Principal Driver	Yes No
Driver 2 Principal Driver	Yes No
Driver 3 Principal Driver	Yes No
Driver Training
Driver 1 Driver Training	No Yes
Driver 2 Driver Training	No Yes
Driver 3 Driver Training	No Yes
Mandatory Coverage's
Help Third Party Liability
Vehicle 1 Third Party Liability	$1,000,000 $2,000,000
Vehicle 2 Third Party Liability	$1,000,000 $2,000,000
Help Accident Benefits (see below for optional increase)
Vehicle 1 - standard
Vehicle 2 - standard
Help Uninsured Automobile Coverage
Vehicle 1 - included
Vehicle 2 - included
Help Direct Compensation Property Damage - Deductible
Vehicle 1 Direct Comp	$0 Standard $300 $500
Vehicle 2 Direct Comp	$0 Standard $300 $500
Optional Coverage's
Help Collision (choose deductible)
Vehicle 1 Collision	$500 $1000 $2500 Not Requred
Vehicle 2 Collision	$300 $500 $1000 $2500 None
Help Comprehensive choose deductible
Vehicle 1 Comp	$300 $500 $1000 $1500 Not Required
Vehicle 2 Comp	$300 $500 $1000 $1500 Not Required
Claims past 3 years IMPORTANT (withholding information can void coverage)
Driver Name claim #1
Driver name claim #2
Date of Claim in last 3 years
Date of Claim in last 3 years
Details of Claim #1
Details of Claim #2
Details and Drivers of other Claims
Driving Convictions past 3 years (Tickets) Give Dates IMPORTANT Information
Conviction Details (Driver & date) *
Conviction Details (Driver & date)
Conviction Details (Driver & date)
Other Information you wish to provide
IMPORTANT! Check if you are employed by any of the following for possible additional 15% discount *	Chamber of Commerce Accademy of Medicine Ottawa Kingston Health Care Worker Canadian Military RCMP Canada Customs & Revenue None
Employer. Many employers have arranged for an employee discount *
Driver Licence number *
Guardsman Insurance Services Inc 613-549-8777 Fax 613-549-5941 2447 Princess Street,  Kingston, ON K7M 3G1

Name *
Street address *
Province *
Postal Code *
Phone *
E-Mail *
Contact Method
Do you understand the following will provide a quote and NO coverage is in effect until confirmed by a Guardsman Broker? *
Do you understand and agree if the answers are materially inaccurate it may result in your policy not being issued, rated, or a claim may be denied? *
How many years have you been insured in Canada / US without interruption? *
Has your insurance been cancelled in the past 3 years for nonpayment? *
Who is your current insurer and expiry date? *
Vehicle 1 year
Vehicle 2 year
Vehicle 1 make
Vehicle 2 make
Vehicle 1 model
Vehicle 2 model
Vehicle Use IMPORTANT HOW FAR DO YOU DRIVE TO WORK ONE WAY *
Vehicle 1 use How far to work 1 way
Vehicle 2 use How far to work 1 way
Vehicle 1 annual KM
Vehicle 2 annual KM
Driver 1 Name
Driver 2 Name
Driver 3 Name
Driver 1 Gender
Driver 2 Gender
Driver 3 Gender
Driver 1 DOB
Driver 2 DOB
Driver 3 DOB
Driver 1 License Class & date licensed
Driver 2 Licence Class & date licensed
Driver 3 Licence Class & date licensed
Driver 1 Years Licenced
Driver 2 Years Licenced
Driver 3 Years Licenced
Driver 1 Principal Driver
Driver 2 Principal Driver
Driver 3 Principal Driver
Driver 1 Driver Training
Driver 2 Driver Training
Driver 3 Driver Training
Vehicle 1 Third Party Liability
Vehicle 2 Third Party Liability
Vehicle 1 Direct Comp
Vehicle 2 Direct Comp
Vehicle 1 Collision
Vehicle 2 Collision
Vehicle 1 Comp
Vehicle 2 Comp
Driver Name claim #1
Driver name claim #2
Date of Claim in last 3 years
Date of Claim in last 3 years
Details of Claim #1
Details of Claim #2
Details and Drivers of other Claims
Conviction Details (Driver & date) *
Conviction Details (Driver & date)
Conviction Details (Driver & date)
Other Information you wish to provide
IMPORTANT! Check if you are employed by any of the following for possible additional 15% discount *
Employer. Many employers have arranged for an employee discount *
Driver Licence number *