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780-352-9222
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Home/Auto Insurance Quote

Home/Auto Insurance Quote Administrator 2021-09-24T14:21:39-06:00

Get a Quote

Insurance isn’t as easy as filling in a few box’s, and getting pricing for the things that matter most you like many online insurers state. Our brokers tailor coverage specifically to you and your needs, meanwhile finding you the lowest premiums for that coverage. Please give us the information we need and we will contact you within 24 hours.

Name*

First Last

Date of Birth*

YYYY dash MM dash DD

Email*

Phone*

Hidden

Phone

Address*

Address Line 1 * Address Line 2 City * State/Province/Region * Zipcode/Postcode * Country *

I may qualify for exclusive insurance rates as an

RCMP

Peace Officer

Sheriff

Police

First Responder

Occupation

Consent*

Do you the applicant authorize the broker to collect, use and disclose personal information including policy history, drivers abstract, claims history, rating information, risk information and your personal credit information including credit score, and provide information to third parties and insurance companies, as required to obtain a quote? Please note this information is not sold or used for any other reason than to maintain your personal information within our Brokerage.

No

Yes

Type of insurance desired*

Auto

Home

Check all that apply

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Auto Insurance

Drivers License number*

Hidden

Number of at fault claims (Collision or Liability)

Gender*

Male

Female

X

Date of first licensed in Canada*

YYYY dash MM dash DD

Date First Insured*

YYYY dash MM dash DD

License Suspension

No

Yes

Insurance Cancelations

No

Yes

Any convictions or driving offenses for which you have been convicted*

No

Yes

(past 4 years)

Any type of insurance claims*

No

Yes

(past 10 years)

Date of conviction

Details and date of claim

Add Another Driver

No

Yes

Additional Driver

Drivers License number*

Gender*

Male

Female

X

Date of first licensed in Canada*

YYYY dash MM dash DD

Date of Birth*

YYYY dash MM dash DD

License Suspension

No

Yes

Insurance Cancelations

No

Yes

Any convictions or driving offenses for which you have been convicted*

No

Yes

(past 4 years)

Any type of insurance claims*

No

Yes

(past 10 years)

Date of conviction

Details and date of claim

Hidden

Invisible

VIN

Vehicle Make*

Vehicle Model*

Vehicle Year*

Vehicles older than 12 years may need a vehicle inspection report

Usage*

Pleasure use only

Work commute

Business use

One-way distance to work (Km)*

Any other relevant information

Home Insurance

Address of home same as address above?*

Yes

No

Date First Insured*

YYYY slash MM slash DD

Claims in the last 10 years?

Yes

No

Home Insurance Cancellations

No

Yes

Home Address*

Address Line 1 * Address Line 2 City * State/Province/Region * Zipcode/Postcode * Country *

Type of residence*

Building construction

Hidden

Building reconstruction value (if known)

Cost to rebuild home excluding land value OR building limit on your current policy

Area of house (sq.ft.)*

Excluding basement

Year Build*

Garage Type*

Attached

Detached

Single

Double

Siding type*

Roof type*

Roof age*

Hot water tank age*

Furnace age*

Plumbing type*

Does your home have a sump pump?*

Yes

No

Does your home have a back water valve?*

Yes

No

Does your home have any alarms or water alarms for security?*

Yes

No

Does your home have a basement?*

Yes

No

Basement (sq.ft.)

Hidden

Finished Basement (%)

% finished

Please enter a number from 0 to 100.

Any other relevant information

Δ

Thank you for your interest in quoting online.

Alberta is in an auto insurance crisis. This is due to:

Increased Claims
Increased insurance Fraud
Unwillingness of the NDP Provincial government to work with the Alberta insurance companies

Due to this we cannot offer payment plans to anyone with cancelled policies due to missed payments.

*Please do not fill out this form, If you would like a quote, please call our office at 1-800-665-6152

Thank you,

Dyck Insurance

DO NOT SUBMIT – Please call for a quote

We are sorry for the inconvenience.

Wetaskiwin

5105 47 Avenue Wetaskiwin, Alberta T9A 0K4

P. 1.780.352.9222
T. 1.800.665.6152
F. 1.780.352.0548

Email Us

Thorsby

Box 530 4902A Hankin Street Thorsby, Alberta T0C 2P0 P. 1.780.789.2424 F. 1.780.789.2135 Email Us

Calmar

Box 870 4915 50 Ave Calmar, Alberta T0C 0V0

P. 1.780.985.3650
F. 1.780.985.3696

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