Online quote - Automobile | Le Groupe Caron et Ménard ltée

Le Groupe Caron et Ménard ltée - Picture

Le Groupe Caron et Ménard will compare several insurance companies to obtain the best product for your specific needs in automobile, residential and commercial insurance at the best premium available.

In completing the fields below, we will be able to evaluate and call you within the next few days with our best quote possible.

The fields marked with an asterisk (*) are mandatory.

Branch : *

Automobile details

First vehicle

Year : *

Make /Model : *

New Used

Use of vehicle : *

Mileage (yearly , approx) : *

Distance to work (one way) :

Mileage for work annually :

Alarm or tracking system : *

Yes No

Antitheft marking : *

Yes No

Integrated cut-off switch : *

Yes No

Creditor /lender :

Second vehicle

Year :

Make /Model :

New Used

Use of vehicle :

Mileage (yearly , approx) :

Distance to work (one way) :

Mileage for work annually :

Alarm or tracking system :

Yes No

Antitheft marking :

Yes No

Integrated cut-off switch :

Yes No

Creditor /lender :

Name : *

Address : *

City : *

Province :

Quebec

Country :

Canada

Postal Code : *

Home phone : *

Business phone :

Email address : *

Marital status : *

Married Single

Main driver

Permit number : *

- -

Permit since (yrs) : *

Date of birth : *

Occupation /employer :

Other driver :

Name :

Permit number :

- -

Permit since (yrs) :

Occupation / employer :

Other driver

Name :

Permit number :

- -

Permit since (yrs) :

Present insurance company :

Renewal date :

Notes :

Coverage required

General liability : *

Collision deductible : *

Comprehensive deductible : *

All perils deductible :

Replacement cost value : *

Yes No

Driving record

Claims over the past 6 years :

	(approx) amount	Date	Collision	Responsible ?
1			Yes No	Yes No
2			Yes No	Yes No
3			Yes No	Yes No

Driver' license suspended : *

Yes No

If yes, please give details :

Demerit points on file : *

I/we authorize a credit verification for quote purposes which could reduce base premiums.

Authorization : *

Yes No