Add a Car
  1. If you need to add a car to your policy, please complete the form below.

  2. First Name(*)
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  3. Last Name(*)
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  4. Address(*)
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  5. City(*)
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  6. Province(*)
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  7. Postal Code(*)
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  8. How would you like us to contact you?
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  9. Daytime Phone
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  10. Night-time Phone
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  11. Best Time To Call
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  12. Email Address
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  13. Useage
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  14. Comp Deductibles
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  15. Collision Deductibles
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  16. Rental Coverage
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  17. Date to Add Vehicle
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  18. Vehicle Year
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  19. Vehicle Make
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  20. Vehicle Model
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  21. How is Vehicle Registered
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  22. Kilometres to Work
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  23. Cost New
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  24. VIN Number
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  25. Lien Holder/Lessee Name
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  26. Lien Holder/Lessee Address
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  27. Garage Address
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  28. Please give any additional comments you feel appropriate. If you have additional information
    where there was not enough fields above, such as additional drivers, vehicles, driver histories, etc..., please enter them here.
  29. Add comments
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  30. First Name
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  31. Last Name
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  32. Current Email Address
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  33. Submit This Form
      
 

DeHart & Stauffer Insurance Brokers Copyright © 2014. All rights reserved.
843 King Street WestOshawa, Ontario L1J 2L4 (905) 576-2234Fax 1-253-550-4655