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Quote Request Form
Hi, please fill out and submit this form for a free, no-obligation insurance quote.
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1
Are you currently a client with HUB?
YES
NO
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2
Are you renewing your existing policy or did you need insurance for something else?
Renewing
Insurance for something else
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3
When does your current policy expire?
(optional, skip if you are unsure)
-
Date
Year
Month
Day
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4
Name
First Name
Last Name
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5
Email
example@example.com
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6
Phone Number
ex: (xxx) xxx-xxxx
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7
Where do you live?
Nunavut
The Northwest Territories
Yukon
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8
What kind of coverage are you interested in?
Select all that apply
Homeowners
Automotive
Snowmobile
Off-Road Vehicle
Boat and Watercraft
Commercial
Employee Benefits
Life and Living Benefits
Outfitters and Guides
Other
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9
What kind of coverage are you renewing?
Select all that apply
Homeowners
Automotive
Snowmobile
Off-Road Vehicle
Boat and Watercraft
Commercial
Employee Benefits
Life and Living Benefits
Other
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10
What make is the Snowmobile/Off-Road Vehicle?
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11
Vehicle Model
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12
Year of Vehicle
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13
Please upload a photo or scan of the Bill of Sale
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
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of
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14
You can reduce your cost of insurance by bundling your home and auto. Can we get you an auto insurance quote as well?
Yes (Car)
Yes (Snowmobile or Off-Road Vehicle)
No thank you
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15
You can reduce your cost of insurance by bundling your auto with your home. Can we get you an homeowner's insurance quote as well?
Yes
No thank you
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16
Which other type of insurance are you interested in?
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17
What kind of coverage are you interested in?
Select one of the insurance products below
Homeowners
Automotive
Commercial
Employee Benefits
Life and Living Benefits
Snowmobile
Off-Road Vehicle
Watercraft
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18
How do you prefer to be contacted?
Phone
Email
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19
OPTIONAL: How did you find HUBNunavut.com?
Facebook
Google
Email
Other
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20
Tags
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In Progress
Done
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