Auto Insurance Quote Application

Fill out our quick form:

We only offer insurance services to residents of Ontario

Are you a resident of Ontario?:
Sorry, we only offer insurance services to residents of Ontario.

Personal Information

First Name / Applicant:
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Last Name:
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City:
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Street Address:
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E-mail:
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Date of Birth:
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Gender:
  • Select One
  • Male
  • Female
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Marital Status:
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  • Single
  • Married
  • Common Law
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Phone Number:
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Vehicle Information

Vehicle Make:
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Vehicle Model:
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Vehicle Year:
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  • 2020
  • 2019
  • 2018
  • 2017
  • 2016
  • 2015
  • 2014
  • 2013
  • 2012
  • 2011
  • 2010
  • 2009
  • 2008
  • 2007
  • 2006
  • 2005
  • 2004
  • 2003
  • 2002
  • 2001
  • 2000
  • 1999
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How long have you owned your vehicle?:
  • Select One
  • < 1 Year
  • 1-3 Years
  • 3-5 Years
  • 5+ Years
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Vehicle Use Info

Total kilometers driven annually:
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Primary Use:
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  • Pleasure and Errands Only
  • Commuting (work or school)
  • Business Use
  • Commercial Use (trades/deliveries etc.)
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Personal Information

When did you first obtain your license?:
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License Class:
  • Select One
  • G
  • G1
  • G2
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Have there been any tickets or claims in the last 10 years?:
  • Select One
  • No
  • Yes
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Are there any additional drivers for this vehicle?:
  • Select One
  • No
  • Yes
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All done!

Once you click submit, your dedicated representative will contact you as soon as possible.

You can receive either a quote online, you can call our office to speak to one of our Professional Brokers, or you can send us a request by fax or email to receive a quote or any information regarding insurance.For your convenience, we offer many different ways for you to receive a quote from us.

Tel. 705-268-9988

Toll Free 888-420-3333

Fax 705-268-4759

email:  insure@bmtinsurance.ca