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Name(s) of insured(s)
New Vehicle
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Any non-factory modifications to the vehicle:
Any unrepaired damage:
Is vehicle leased or financed:
If yes, specify whether leased or financed:
Will adding this vehicle result in changes in use of other:
Collision coverage and deductible requested:
Comprehensive coverage and deductible requested:
All perils coverage and deductible requested:
Driver #1
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Driver #2
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Driver #3
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Effective Date
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About Your Insurance (Specify the policy to which this change applies)

Disclaimer

Only the person named as the insured in the policy documents can make changes to the policy. By submitting this form, you acknowledge that you are the policyholder and are authorized to make changes to your information.

Please be advised that coverage cannot be bound nor can any additions or deletions to coverage be made by leaving a voice mail message, email message or by submitting this form. Coverage is only confirmed once you have spoken directly with a licensed insurance broker.

If you have not received an acknowledgement within one business day, please contact our office and speak directly to one of our licensed insurance brokers. Mink Insurance Services Ltd. is not responsible for instructions not received. All policy terms and conditions apply, subject to policy status at time of submission.

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Did You Know

BEGINNING OCTOBER 2018 OUR OFFICE WILL NO LONGER BE OPEN ON SATURDAY MORNINGS

We still want you to be able to contact us:

For Claims Service:  Please refer to our Company specific list of after hours phone numbers to call them direct, or our Emergency phone # is 705 529 4142.

For General Inquiries:  These will be handled on the following Monday (Tuesday if long weekend).  Please call and leave a message in our general mailbox 705 527 6465 ext 101 or email insurance@minkinsurance.com with your inquiry.

If you are only able to come into our office on a Saturday:   Please call in advance to arrange an appointment with the broker that you need to see.

Disclaimer:  If you call and leave a voice mail, or email us, to make any change or request new coverage - it wil NOT be effective until confirmed by a licenced broker of Mink Insurance.

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