Contact Information

Full Name

Full Address

Postal-Code

City

If you have lived at your address for less than 3 years, please provide your previous address:

Phone Number

Email Address

I agree to receive email correspondence from Alpine Insurance & Financial Inc. in accordance with Canada's Anti-Spam Legislation (CASL)

Next Steps...

To provide the most accurate quote possible we need to gather some more details from you. You can choose to have a representative contact you to go over the quote on the phone, or fill out the online form in full. Please select your preferred option:

I would like to complete the form online.

I would like to have a representative contact me.

Step 2: Details

Please fill out as much information as possible. If you do not complete all of the fields, a representative may need to contact you in order to collect the missing information.

How many drivers do you need a quote for?

Driver #1

Gender

Driver's License Number

Date you were first issued a class 5 in Canada

Date of your first license that let you drive alone.

Date of Birth

Marital Status

Occupation & Employer Name

Alpine has many different discounts for occupation and employer.

Are you a member of any group or association?

Have you taken a Drivers Training course in Canada?

Step 3: Insurance History

Please fill out as much information as possible.

Driver #1

Are you currently insured?

Have you had insurance claims in the last 6 years?

Have you had any tickets or convictions in the last 3 years (including suspensions)?

Have you ever been cancelled for non-payment on your insurance in the last 3 years?

Step 4: Vehicle Details

Just a few more questions...

Driver #1 Vehicle

Year, Make & Model

VIN#

Purchase Price

Date Purchased

How many KM will you drive (average) per year?

Will this vehicle be used to commute to work or school?

Will this vehicle be used for business, commercial, delivery, carrying tools or supplies, visiting clients etc?

Last Step: Coverage Options

Please answer these last few questions and we'll get to work on your quote!

Driver #1 Coverage

When do you need the coverage to start?

Liability Limit

Collision (coverage for damage to your own vehicle)

Comprehensive (Fire/Theft/Vandalism/Hail/etc)

What deductible do you want?

Do you want to combine any other policies for additional discounts?

Additional Policies

Do you consent to a soft credit check?

Some of our insurance companies require a soft credit check to qualify for certain discounts. The soft check won’t affect your credit score.

Additional Comments

Car / Auto Insurance Quote

Contact Information

Next Steps...

Step 2: Details

Driver #1

Step 3: Insurance History

Driver #1

Step 4: Vehicle Details

Driver #1 Vehicle

Last Step: Coverage Options

Driver #1 Coverage

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