Allstate Request Form

Hagerty Lead Form
Minimum Driver and Vehicle Qualifications for Hagerty Insurance
In order to qualify for our Agreed Value classic car insurance, the following minimum requirements must be met.

Driver Eligibility:

Applicants and household drivers must have 10 or more years of driving experience.

All household driving records and prior claims are subject to underwriter review.

We consider all violations, suspensions, at-fault accidents and comprehensive claims.

Generally, one or two minor violations or accidents are acceptable. We can't offer coverage to drivers with a serious infraction within the last three years. Serious infractions include:

·         Alcohol-related offences

·         Reckless driving

·         Excessive speed violations

Vehicle Usage: Our policy allows reasonable pleasure use, with no fixed restrictions — it just can't be used as a daily driver.

Storage: Though we prefer that collector vehicles are stored in an enclosed, secure structure when not in use — such as a private garage, pole barn or storage unit — we will consider other storage types, including carports, driveways, parking garages, or car hauling trailers.

Regular-Use Vehicles: All household members with a valid driver's licence must have a regular-use vehicle for daily driving, covered with regular-use insurance in that driver's name. Motorcycles and public transportation are not considered viable regular use vehicles by our program in most cases (contact us for details).
Vehicles That May Not Qualify:

Because we provide low-cost, agreed value coverage, we are not able to provide coverage for certain vehicles due to how they are used and the increased risk associated. Examples of vehicles not eligible include:

·         Daily-use vehicles

·         Camping, off-road, or utility-type vehicles

·         Late model vehicles that have been highly customized for looks or performance (commonly referred to as “Tuner”)

·         Vehicles that are highly customized for appearance and suspension (commonly referred to as "Lowrider")

·         Commercial-use vehicles

·         Motorcycles or scooters

·         High production late model vehicles and pick-ups with no special characteristics

·         High performance vehicles with a top speed of 298 kph and the operator(s) does not have experience driving a similar vehicle for at least three years or has less than 25 years driving experience in Canada or the United States

·         Replicas of the 1963-67 Shelby Cobra Roadster (exception: British Columbia, Manitoba and Saskatchewan)

·         Vehicles that are used for racing, timed events, autocross or drivers education

·         Vehicles modified with features such as a roll cage, wheelie casters, parachutes, nitrous components or modifications that permanently remove the roof and/or doors

·         Vehicles with 700 hp or greater (manufactured or modified)

·         Right-hand drive vehicles newer than 25 years, specifically those imported from Japan such as a Nissan Skyline or Toyota Supra or Landcruiser

·         Dune Buggies

·         Motor homes or recreational vehicles
Appraisals:

Appraisals are not required in most cases, however, Hagerty reserves the right to require an appraisal if necessary to agree on a value.
How to Contact Hagerty if you have questions:

If you have questions please email them to AllstateCanada@Hagerty.com

That inbox is monitored by several members of the Hagerty team during regular business hours.
Applicant Information
Name *

First Name Last Name
Email
example@example.com
Date of Birth *

Month Day Year
Date
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City Province

Postal Code
Year, Make, Model of Applicant's Daily Driver *
Collector Vehicle Information
Year, Make, Model *
VIN
Value (if known)
Stock or Modified
Other Information About the Collector Vehicle
Information about any additional collector vehicles owned by the applicant (please include year, make, model, value if known, VIN and whether it is stock or modified)
Hagerty Quote Number (if you already did a quote on the Hagerty portal)
Name of Allstate Agent *

First Name Last Name
Email Address of Allstate Agent *
example@example.com
Office Location of Allstate Agent *
The client mentioned above consents to have their information shared with Hagerty Canada, LLC. The client agrees to be contacted and understands that a Hagerty Canada, LLC Licensed Sales Agent will provide them with more information on services. They also understand there is no obligation to buy at this time. *
The client mentioned above has been informed of the potential receipt of a referral fee by Allstate. *
The client mentioned above has been informed that data may be stored and processed in the United States. *
Should be Empty:

Hagerty Lead Form