Covid 19 Update Our office will continue to be open if you need to drop off a payment, sign paperwork, etc. However we are currently not doing in office appointments. If you need to discuss your insurance policies with one of our brokers, please give us a call at 905-623-4406 or send us an email at info@jamesinsurancebroker.com.

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Call us today 905-623-4406!

Local Insurance Broker serving Bowmanville Since 1893

905-623-4406 info@jamesinsurancebroker.com

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Please complete the form below and one of our brokers will be in contact with you as soon as possible. If you would like immediate assistance please call the office at 905-623-4406.

- Step 1 of 5

Name *

First

Last

Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Number of Drivers *

Number of Vehicles *

Name of First Driver *

First

Last

Date of G1 Driver 1 *

Date of G2 Driver 1 *

Date of G Driver 1 *

Number of Tickets in Past 3 Years *

Number of At Fault Accidents in Past 10 Years *

Description of Tickets and/or At Fault Accidents *

Name of Second Driver *

First

Last

Date of G1 Driver 2 *

Date of G2 Driver 2 *

Date of G Driver 2 *

Number of Tickets in Past 3 Years *

Number of At Fault Accidents in Past 10 Years *

Description of Tickets and/or At Fault Accidents *

Name of Third Driver *

First

Last

Date of G1 Driver 3 *

Date of G2 Driver 3 *

Date of G Driver 3 *

Number of Tickets in Past 3 Years *

Number of At Fault Accidents in Past 10 Years *

Description of Tickets and/or At Fault Accidents *

Name of Fourth Driver *

First

Last

Date of G1 Driver 4 *

Date of G2 Driver 4 *

Date of G Driver 4 *

Number of Tickets in Past 3 Years *

Number of At Fault Accidents in Past 10 Years *

Description of Tickets and/or At Fault Accidents *

Year, Make and Model Of Vehicle 1 *

VIN Number *

Primary Driver *

Does it have snow tires installed during the winter months? *

Use of Vehicle *

Commuting to Work/School
Business or Commercial Use
Pleasure Use Only

Number of KM One Way to Work or School *

Annual KM *

Year, Make and Model Of Vehicle 2 *

VIN Number *

Primary Driver *

Does it have snow tires installed during the winter months? *

Use of Vehicle *

Commuting to Work/School
Business or Commercial Use
Pleasure Use Only

Number of KM One Way to Work or School *

Annual KM *

Have All Drivers Been Insured Since Licensed? *

Any Cancellations for Non-Payment in the Past 3 Years? *

No
Yes - 1
Yes - More than 1

Current Insurance Company

Number of Years With Current Insurer

Renewal Date of Your Current Policy (Leave Blank If You Do Not Have a Current Policy)

Additional Information or Comments:

About Us

James Insurance is a local insurance broker serving Bowmanville and the surrounding areas since 1893.

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Contact Us

26 King St E
Bowmanville ON L1C 1N2
T: 905-623-4406
T: 1-800-836-7236
F: 905-623-5570
Email:
info@jamesinsurancebroker.com

Our Hours

Monday: 9AM - 5PM
Tuesday: 9AM - 5PM
Wednesday: 9AM - 5PM
Thursday: 9AM - 5PM
Friday: 9AM -4PM
Saturday: Closed
Sunday: Closed

Insurance Products

Auto Insurance
House Insurance
Condo Insurance
Tenant Insurance
Farm Insurance
Business Insurance
Recreational Insurance

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