Forever Young Insurance Brokers FOREVER YOUNG INSURANCE BROKERS
105 WEST BEAVER CREEK RD., RICHMOND HILL, ONT, L4B 1C6
1-866-779-7283 ~ 905-762-1874 ~ FAX 905-764-9618
Committed To Excellence and Peace of Mind Insurance Since 1979
 


4 Minute Quoter

To Change your VEHICLE use and distance to work, email to Broker

We will forward it to your Personal Broker
 
  First Name  
  Last Name  
Postal Code
       
  Email
Policy Number
  Insurance Company
  Effective Date of your Requested Change
  Did you stop using your car to commute to work?
    Yes, I stopped using my car to commute to work.
    No, I still use my car to commute to work.
    No, I wasn't using my car to commute to work in the first place.
  Have your driving habits changed (ex: using your car for essential travel only)?
    Yes, my driving habits have changed and and the kilometres I drive have decreased.
    No, my driving habits have not changed.
    I confirm that the information above is true, complete and accurate.
  Indicate which vehicles are affected by the usage changes:
 
 
Make Model Year
 
 
Make Model Year
 
 
Make Model Year
  Your Comments  
For Your Records, Before Submitting The Form

WARNING: DISTRACTED DRIVING IS NOW CONSIDERED A MAJOR OFFENCE (6 POINTS!!)AND CAN LEAD TO LICENSE SUSPENSION, HIGHER RATES AND CANCELLATION OF YOUR POLICY!!!

We appreciate your referrals! Keep us in mind if any of your friends or associates would like to save money on their insurance, and better their coverage!

WE CANNOT BIND OR HOLD ANY COVERAGE FROM EMAILS....DO NOT ASSUME YOU HAVE COVERAGE UNLESS YOU HAVE A BINDER OR LETTER BACK FROM OUR OFFICE CONFIRMING COVERAGE HAS BEEN ISSUED WITH THE INSURANCE COMPANY.
 
 
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