Autopac Form

Please complete the form below so we can process your autopac insurance request.

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Type of Transaction
First Name
Last Name
Email Address
Phone
Date of Birth
Driver's License Number
City
Additional Information

By checking the box below, you consent to receiving your personal information, insurance forms and, if applicable, banking information by email.
I agree and understand my insurance is NOT renewed and my coverage will NOT take effect until a licensed insurance representativehas contacted me and has confirmed coverage is bound.
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I consent to the use of my personal information for the purpose of advising me of other insurance and financial products during this term:


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Vehicle Replacement Insurance gives you peace of mind for drivers of new and used vehicles for up to 7 years

On average, vehicles lose over 50%* of its value within the first 4 years…

Your primary insurer may not cover the amount owing on your vehicle loan or lease after a total loss, not to mention providing you with any equity towards your replacement vehicle. Replacement Vehicle Insurance ensures that you do not lose your financial investment along with your vehicle.