Home Insurance
Condo Insurance
Tenant Insurance
Cottage or Seasonal Property Insurance
Life & Health Insurance
Travel Insurance
Umbrella Liability Insurance

Auto Insurance
Classic Car Insurance
Motorcycle Insurance
ATV & Snowmobile Insurance
Motorhome & Trailer Insurance
Watercraft Insurance
Personal Cyber Insurance

Industry Specific Insurance Policies
Farm Insurance
Commercial Property Insurance
Commercial Liability Insurance
Professional Liability Insurance
Surety Bonding Insurance
Commercial Auto & Fleet Insurance
Cyber Liability & Privacy Breach Insurance
Legal Expense Coverage

Cottage Associations
Bruce Power
Hole In One Insurance

Our Team
Contact Us
Daniel & Melanie Craig Memorial Tournament
Community Involvement
Testimonials
Join Our Team
Companies We Represent

Self Serve
Make A Payment
Make a Claim
News
Refer A Friend

Home Insurance
Condo Insurance
Tenant Insurance
Cottage or Seasonal Property Insurance
Life & Health Insurance
Travel Insurance
Umbrella Liability Insurance

Auto Insurance
Classic Car Insurance
Motorcycle Insurance
ATV & Snowmobile Insurance
Motorhome & Trailer Insurance
Watercraft Insurance
Personal Cyber Insurance

Industry Specific Insurance Policies
Farm Insurance
Commercial Property Insurance
Commercial Liability Insurance
Professional Liability Insurance
Surety Bonding Insurance
Commercial Auto & Fleet Insurance
Cyber Liability & Privacy Breach Insurance
Legal Expense Coverage

Cottage Associations
Bruce Power
Hole In One Insurance

Our Team
Contact Us
Daniel & Melanie Craig Memorial Tournament
Community Involvement
Testimonials
Join Our Team
Companies We Represent

Self Serve
Make A Payment
Make a Claim
News
Refer A Friend

Contact Us

1-800-282-1915

Client Portal Menu

Quote Form

Auto Insurance

1Basic Information

2Vehicle Information

3Driver Information

4Coverage Date & Submit

Basic Information - PLEASE NOTE after completing this form a Broker will contact you to provide your quote
Full Name*
Phone
Email Address*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Total number of vehicles in household*
Numbers of licensed drivers living in your household (including yourself):*

Vehicle Information
Vehicle Year*
Vehicle Make*
Vehicle Model*
VIN (optional)
Purchase or lease date of vehicle (mm/yyyy):*
Purchase Condition:*
- New
- Used
Approximate number of kilometres driven annually:*
If you use your vehicle to go to work or school, please list your commute distance (one-way):
Is vehicle used for any business or commercial purposes:*
- Yes
- No
Name of the primary driver of this vehicle:*
Winter tires (All Season tires do not quality as winter tires):*
- Yes
- No
Add Additional Vehicle?
- No
- Yes
Additional Vehicle Information
Vehicle Year*
Vehicle Make*
Vehicle Model*
VIN (optional)
Purchase or lease date of vehicle (mm/yyyy):*
Purchase Condition:*
- New
- Used
Approximate number of kilometres driven annually:*
If you use your vehicle to go to work or school, please list your commute distance (one-way):
Is vehicle used for any business or commercial purposes:*
- Yes
- No
Name of the primary driver of this vehicle:*
Winter tires (this discount is not available with "All Season" tires):*
- Yes
- No
Add Additional Vehicle?
- No
- Yes
Additional Vehicle Information
Vehicle Year
Vehicle Make
Vehicle Model
VIN (optional)
Purchase or lease date of vehicle (mm/yyyy):*
Purchase Condition:
- New
- Used
Approximate number of kilometres driven annually:
If you use your vehicle to go to work or school, please list your commute distance (one-way):
Is vehicle used for any business or commercial purposes:
- Yes
- No
Name of the primary driver of this vehicle:
Winter tires (this discount is not available with "All Season" tires):
- Yes
- No

Driver Information
Driver Name*
Date of birth*
MM slash DD slash YYYY
Driver's license number
Marital status:*
License Class*
Date First Licensed (Year/Month)
Completed Driver's Training Program:
- No
- Yes
CAA Membership Number
CAA offers discounted auto insurance rates for members. CAA is one of many markets we represent and we will get you a quote that includes your membership discount.
Years continuously insured:*
Years with current insurance company:*
Number of traffic tickets (excluding parking tickets) in the past 3 years:*
Number of claims, NOT involving accidents, in the past 6 years*
Number of claims involving accidents in the past 6 years*
Number of times driver's license suspended in the past 6 years:*
Number of times insurance coverage has been cancelled by an insurance company in the past 5 years:*
This field is hidden when viewing the form
Reason for most recent cancellation:
Add Additional Driver?
- No
- Yes
Additional Driver Informaton
Full Name
Date of birth
MM slash DD slash YYYY
Driver's licenses number
Marital status
License class:
Date First Licensed (Year/Month)
Completed Driver's Training Program
- No
- Yes
CAA Membership Number
CAA offers discounted auto insurance rates for members. CAA is one of many markets we represent and we will get you a quote that includes your membership discount.
Years continuously insured:
Years with current insurance company:
Number of traffic tickets (excluding parking tickets) in the past 3 years:
Number of claims, NOT involving accidents, in the past 6 years
Number of claims involving accidents, in the past 6 years
Number of times driver's license suspended in the past 6 years:
Number of times insurance coverage has been cancelled by an insurance company in the past 5 years:
Reason for most recent cancellation:
Add Additional Driver?
- No
- Yes
Additional Driver Informaton
Full name
Date of birth
MM slash DD slash YYYY
Driver's licenses number
Martial status
License class:
Date First Licensed (Year/Month)
Completed Driver's Training Program:
- No
- Yes
CAA Membership Number
CAA offers discounted auto insurance rates for members. CAA is one of many markets we represent and we will get you a quote that includes your membership discount.
Years continuously insured:
Years with current insurance company:
Number of traffic tickets (excluding parking tickets) in the past 3 years:
Number of claims, NOT involving accidents, in the past 6 years
Number of claims involving accidents, in the past 6 years
Number of times driver's license suspended in the past 6 years:
Number of times insurance coverage has been cancelled by an insurance company in the past 5 years:
Reason for most recent cancellation:

General Comments
Coverage Start Date:
MM slash DD slash YYYY
If there is a specific CMR Broker you would prefer to deal with please enter their name here:
How did you hear about CMR Insurance?
If someone referred you to CMR, please provide their full name in the text box to the right so that we can send them a proper thank you

Δ

We have 10 office locations to serve you better! Find the closest to you.

Durham

Hanover

Mildmay

Walkerton

Collingwood

Southampton

Wiarton

Paisley

Meaford

Owen Sound

Sign up to receive our news:

Full name
Email

Δ

Compensation Disclosure

Terms of use

Privacy Policy Terms of Use Accessible Client Service Policy RIBO Insurance Broker Fact Sheet CISRO Principals of Conduct for Insurance Intermediaries Compensation Disclosure Combined Disclosure Obligations