Automobile Insurance
Quote Sheet
 
Instructions: Please fill in the following information and a Qualified Johnston Meier Insurance Representative will contact you with your quote. 

Note: Quoted prices are only valid within the Province of British Columbia, Canada.

1.
Vehicle Make
2.Model
3.Year
4.Requested Liability Limit
5.Requested Collision Deductible
6.Requested Comprehensive Deductible
7.Loss of Use 
8.Discount Level 
9.Payment Method
10.Requested Term
11.Vehicle Use
12.Where is Vehicle normally parked at night?
13.Passive Immobilizer?
.
This form is for estimating purposes only.
Additional information may be required in order to
verify rating. One of our qualified representatives will
contact you to confirm the information provided.
.
Contact Information
Name
Address
City
Postal Code
Email Address
Telephone #
Fax #