Travel 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.Type of Coverage
2.
Number of Days Required
3.Number of Household Members to be included
4.Age of Applicants
5.Travel to USA
6.Pre-existing conditions apply
.
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 #