As you complete the form below, here is some basic information to keep in mind:

Collision – Covers your vehicle if you hit, or is hit, by another object or the ground, or if your auto rolls over.

Comprehensive – Fire, lightning, vandalism, windstorm or hail – acts of nature.

Liability – Covers you if you cause bodily injury or property damage.

Road Hazard Glass – Covers glass that has been broken by an object that was thrown up or fell from another vehicle. Coverage cannot be added if glass has any unrepaired damage.

Loss of Use – This covers you if you are at fault in a collision, policy will give you a limit towards a rental vehicle while your vehicle is being repaired.

Replacement Cost Coverage – This is only available for the first 3 years if the vehicle is brand new. Coverage needs to be added on within the first 120 days of delivery as per the date shown on Bill of Sale. Replacement Cost Coverage protects your vehicle from depreciation.

Applicant's Information
Insured's Information
Coverage Requested