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Get An Estimate

Fill out the form below and let us know what type of coverage you’re looking for.

Thanks for asking us to provide you with a premium estimate on your insurance needs! This form will allow you to request an estimate for our Auto, Business, Farm, or Home Coverage, or any combination there-of. The more accurate information you can provide the better service we can offer you. To get started, please tell us a little bit about yourself:

Name
First Last
Address
Street Address Address Line 2 City Province Postal Code
Phone
(###) ###-####
Cell Phone
(###) ###-####
Email
Preferred Start Date of Policy
Preferred Method of Contact
Best time of day to call?
Type of Estimate Requested
Please let us know what type of coverage you'd like a quote for. You can select more than one type and the form fields below will change based on your selections.
- Auto Coverage
- Business Coverage
- Farm Coverage
- Home Coverage
Auto Coverage Details
Number Of Vehicles
- None
- One
- Two
- Three
- Four
If more than 4, please contact us directly.
Vehicle One
Year
Make
Model
Vehicle Use
Daily Commute (one way)
Annual Distance
Collision
Comprehensive
Current Liability
Vehicle Two
Year
Make
Model
Vehicle Use
Daily Commute (one way)
Annual Distance
Collision
Comprehensive
Current Liability
Vehicle Three
Year
Make
Model
Vehicle Use
Daily Commute (one way)
Annual Distance
Collision
Comprehensive
Current Liability
Vehicle Four
Year
Make
Model
Vehicle Use
Daily Commute (one way)
Annual Distance
Collision
Comprehensive
Current Liability
Drivers
Number of Drivers
If more than four drivers, please contact us directly.
- One
- Two
- Three
- Four
Driver One
Driver One Name
First Last
Driver One Date of Birth
Month
Day
Year
How many years licensed (in Canada)?
How many years with continuous auto insurance?
License Class
How many convictions/driving violations/tickets has Driver One had during the past 3 years?
How many at-fault accidents has Driver One been involved in during the last 6 years?
Has Driver One's auto insurance ever been cancelled for any reason during the past 6 years?
Has Driver One's drivers license been suspended during the past 6 years?
Driver Two
Driver Two Name
First Last
Driver Two Date of Birth
Month
Day
Year
How many years licensed (in Canada)?
How many years with continuous auto insurance?
License Class
How many convictions/driving violations/tickets has Driver Two had during the past 3 years?
How many at-fault accidents has Driver Two been involved in during the last 6 years?
Has Driver Two's auto insurance ever been cancelled for any reason during the past 6 years?
Has Driver Two's drivers license been suspended during the past 6 years?
Driver Three
Driver Three Name
First Last
Driver Three Date of Birth
MM slash DD slash YYYY
How many years licensed (in Canada)?
How many years with continuous auto insurance?
License Class
How many convictions/driving violations/tickets has Driver Three had during the past 3 years?
How many at-fault accidents has Driver Three been involved in during the last 6 years?
Has Driver Three's auto insurance ever been cancelled for any reason during the past 6 years?
Has Driver Three's drivers license been suspended during the past 6 years?
Driver Four
Driver Four Name
First Last
Driver Four Date of Birth
MM slash DD slash YYYY
How many years licensed (in Canada)?
How many years with continuous auto insurance?
License Class
How many convictions/driving violations/tickets has Driver Three had during the past 3 years?
How many at-fault accidents has Driver Three been involved in during the last 6 years?
Has Driver Three's auto insurance ever been cancelled for any reason during the past 6 years?
Has Driver Three's drivers license been suspended during the past 6 years?
Business Coverage Details
Please provide a little info about your business.
Please describe your business:
How many years have you carried business insurance?
Current Liability Limit
Gross Annual Revenue
How many business insurance claims have you made during the past 5 years?
Have you ever been cancelled or refused business insurance?
Farm Coverage Details
Please tell us a little bit about your farm.
Type of Farm
Please describe your farming operation:
How many years have you been farming?
How many farm insurance claims have you had in the past 5 years?
Have you ever been cancelled or refused farm insurance?
Home Coverage Details
Please tell us a little bit about your home/property.
Type of Home Policy
Year Built
How many square feet approximately?
Style of Home
How many claims have you had in the past 5 years?
Have you ever been cancelled or refused home insurance?

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Get An Estimate

Auto Coverage Details

Vehicle One

Vehicle Two

Vehicle Three

Vehicle Four

Drivers

Driver One

Driver Two

Driver Three

Driver Four

Business Coverage Details

Farm Coverage Details

Home Coverage Details

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Together, We Are Stronger

Via staff outreach and the mutual model, Stanley Mutual is a force of positive change in our community. Join us.