Auto Insurance

Auto Insurance Quote

Are you looking to improve your current automobile insurance:

• Service?
• Coverages?
• Pricing?

At Halpenny Insurance, our clients benefit by having access to several top insurance companies focused in providing the most competitive premiums, broadest coverages, backed by the highest levels of customer service in the industry. Please complete the form below, click “REQUEST A QUOTE” and one of our representatives will contact you to review your needs.

• Name * First Last
• Email *
• Address *
  Street Address Address Line 2 City Province Postal Code Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea GuineaBissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe Country
• Phone *
• Have you ever had insurance cancelled or refused?
  Yes No
• Do you currently insure your car?
  Yes No
• How many years have you had continuous automobile insurance coverage?
• When should coverage start? MM / DD / YYYY

• Driver(s) Information

  Please provide information on all drivers to be covered by this policy.

• 	Driver 1	Driver 2	Driver 3
  Name
  Date of Birth	MM / DD / YYYY	MM / DD / YYYY	MM / DD / YYYY
  Licensed years in Canada
  License class	Choose G G1 G2	Choose G G1 G2	Choose G G1 G2
  Gender	Choose Male Female Prefer Not to Answer	Choose Male Female Prefer Not to Answer	Choose Male Female Prefer Not to Answer
  Marital Status	Choose Married Single Common Law	Choose Married Single Common Law	Choose Married Single Common Law
  Driving School?	Choose Yes No	Choose Yes No	Choose Yes No
  Minor traffic convictions in the last 3 years	Choose none 1 2 3	Choose none 1 2 3	Choose none 1 2 3
  Major traffic convictions (careless or impaired driving, refusing breathlyzer, etc.)	Choose none 1 2 3	Choose none 1 2 3	Choose none 1 2 3
  Any suspensions or cancellations of license last 6 years?	Choose Yes No	Choose Yes No	Choose Yes No
  Number of accidents or other automobile insurance claims in the last 6 year?	Choose 1 2 3 more than 3	Choose 1 2 3 more than 3	Choose 1 2 3 more than 3

• Vehicle information

  Please provide vehicle information and required coverages below.

• 	Vehicle #1	Vehicle #2
  Vehicle Make
  Year
  Model
  Style	Choose 2 Door 2 Door Hatch 4 Door 4 Door Hatch Wagon SUV Pickup Van	Choose 2 Door 2 Door Hatch 4 Door 4 Door Hatch Wagon SUV Pickup Van
  Use	Choose Pleasure Commute < 10 km Commute 10 to 24 km Commute 24+ km Partial Business Business	Choose Pleasure Commute < 10 km Commute 10 to 24 km Commute 24+ km Partial Business Business
  Kilometers driven per year	Choose 05000 5001 10000 10001 15000 15001 20000 20001 25000 over 25000	Choose 05000 5001 10000 10001 15000 15001 20000 20001 25000 over 25000
  Who is primary driver?	Choose Driver #1 Driver #2 Driver #3	Choose Driver #1 Driver #2 Driver #3

• Coverage Required

• 	Vehicle #1	Vehicle #2
  Liability	Choose $1,000,000 $2,000,000	Choose $1,000,000 $2,000,000
  Collision Deductible	Choose $500 $1,000	Choose $500 $1,000
  Comprehensive Deductible	Choose 300 500 1000	Choose 300 500 1000

• If you want to submit this form, do not enter anything in this field

QUICK LINKS

Auto Insurance Quote

Home Insurance Quote

Commercial Insurance Quote

Financial Services / Benefits Quote

CONTACT US

1550 Laperriere Ave.
Ste. 100
Ottawa, Ontario
K1Z 7T2

Phone: (613) 722-7626
Toll Free: 1-800-635-3508
Fax: (613)722-5382
Email: info@halpenny.com

CLAIMS

Call 613-722-7626