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Personal Information
Name*
First Name Last Name
Phone Number*
Email Address*
Street Address*

Please include apartment number if applicable.
Address Line 2
City*
Postal Code*
Province*
- Nova Scotia
- New Brunswick
- Newfoundland
Please note we are only licensed to sell insurance in these provinces.
How do you want us to contact you?*
- Phone
- Email
When would you like us to call you?
- As soon as possible
- Certain hours work best for me
Please let us know when works best for you
We're open Mon - Fri from 8:30am - 5:30pm (excluding holidays). If there isn't a time within this range that works for you, please select that you'd like us to contact you via email above.

Vehicle Information
Vehicle 1
Year*
Make*
Model*
Liability Coverage*
- $500,000 Liability Limit
- $1,000,000 Liability Limit
- $2,000,000 Liability Limit (Recommended)
Protects the insured vehicle owner in the event the vehicle causes injury, death or property damage to a third-party resulting from the driver's negligence while operating the vehicle.
Collision Coverage*
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Collision Coverage
Helps cover the cost of repairing or replacing your own vehicle if it's damaged in an at-fault accident. Please choose the deductible you would like for this coverage - a deductible is the amount you are responsible for paying out-of-pocket in the event of a claim before this insurance coverage kicks in.
Comprehensive Coverage*
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Comprehensive Coverage
Helps cover the cost of repairing or replacing your vehicle if it's damaged by other unexpected situations, such as fire, theft or attempted theft, vandalism. glass repair, falling or flying objects, insured natural disasters, or riots or civil disobedience. Please choose the deductible you would like for this coverage - the deductible is the amount you are responsible for paying out-of-pocket in the event of a claim before this insurance coverage kicks in.
Additional Coverages
- Replacement Rental Vehicle (SEF 20)
- Extend Coverage to a Rental Vehicle (SEF 27)
- Accident Waiver (SEF 39)
- Emergency Roadside Service Coverage - (SEF 35)
- Waiver of Depreciation Coverage (Brand New Vehicle Only) - (SEF 43R)
Please check any additional coverages you are interested in having included on your quote.
+ Add Vehicle
Vehicle 2
- Remove Vehicle
Year
Make
Model
Liability Coverage
- $500,000 Liability
- $1,000,000 Liability
- $2,000,000 Liability
Third Party Liability protects the insured Nova Scotia driver and/or the registered vehicle owner in the event they cause injury, death or property damage to a third-party resulting from the driver's negligence in operating the motor vehicle.
Collision Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Collision Coverage
Helps cover the cost of repairing or replacing your own vehicle if it's damaged in a collision. Please choose the deductible you would like for Collision coverage. The deductible is the amount you are responsible to pay in the event of a collision claim.
Comprehensive Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Comprehensive Coverage
Comprehensive coverage for the cost of repairing or replacing your vehicle up to the actual cash value if it's damaged by other unexpected situations such as falling or flying objects, vandalism, fire, theft or attempted theft, glass repair, a natural disaster, or a riot or civil disobedience less the deductible you choose.
Additional Coverages
- Replacement Rental Vehicle (SEF 20)
- Extend Coverage to a Rental Vehicle (SEF 27)
- Accident Waiver (SEF 39)
- Emergency Roadside Service Coverage - (SEF 35)
- Waiver of Depreciation Coverage (Brand New Vehicle Only) - (SEF 43R)
Please check any additional coverages you are interested in having included on your quote.
+ Add Vehicle
Vehicle 3
Year
Make
Model
Liability Coverage
- $500,000 Liability
- $1,000,000 Liability
- $2,000,000 Liability
Third Party Liability protects the insured Nova Scotia driver and/or the registered vehicle owner in the event they cause injury, death or property damage to a third-party resulting from the driver's negligence in operating the motor vehicle.
Collision Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Collision Coverage
Helps cover the cost of repairing or replacing your own vehicle if it's damaged in a collision. Please choose the deductible you would like for Collision coverage. The deductible is the amount you are responsible to pay in the event of a collision claim.
Comprehensive Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Comprehensive Coverage
Comprehensive coverage for the cost of repairing or replacing your vehicle up to the actual cash value if it's damaged by other unexpected situations such as falling or flying objects, vandalism, fire, theft or attempted theft, glass repair, a natural disaster, or a riot or civil disobedience less the deductible you choose.
Additional Coverages
- Replacement Rental Vehicle (SEF 20)
- Extend Coverage to a Rental Vehicle (SEF 27)
- Accident Waiver (SEF 39)
- Emergency Roadside Service Coverage - (SEF 35)
- Waiver of Depreciation Coverage (Brand New Vehicle Only) - (SEF 43R)
Please check any additional coverages you are interested in having included on your quote.
+ Add Vehicle
Vehicle 4
Year
Make
Model
Liability Coverage
- $500,000 Liability
- $1,000,000 Liability
- $2,000,000 Liability
Third Party Liability protects the insured Nova Scotia driver and/or the registered vehicle owner in the event they cause injury, death or property damage to a third-party resulting from the driver's negligence in operating the motor vehicle.
Collision Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Collision Coverage
Helps cover the cost of repairing or replacing your own vehicle if it's damaged in a collision. Please choose the deductible you would like for Collision coverage. The deductible is the amount you are responsible to pay in the event of a collision claim.
Comprehensive Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Comprehensive Coverage
Comprehensive coverage for the cost of repairing or replacing your vehicle up to the actual cash value if it's damaged by other unexpected situations such as falling or flying objects, vandalism, fire, theft or attempted theft, glass repair, a natural disaster, or a riot or civil disobedience less the deductible you choose.
Additional Coverages
- Replacement Rental Vehicle (SEF 20)
- Extend Coverage to a Rental Vehicle (SEF 27)
- Accident Waiver (SEF 39)
- Emergency Roadside Service Coverage - (SEF 35)
- Waiver of Depreciation Coverage (Brand New Vehicle Only) - (SEF 43R)
Please check any additional coverages you are interested in having included on your quote.
+ Add Vehicle
Vehicle 5
Year
Make
Model
Liability Coverage
- $500,000 Liability
- $1,000,000 Liability
- $2,000,000 Liability
Third Party Liability protects the insured Nova Scotia driver and/or the registered vehicle owner in the event they cause injury, death or property damage to a third-party resulting from the driver's negligence in operating the motor vehicle.
Collision Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Collision Coverage
Helps cover the cost of repairing or replacing your own vehicle if it's damaged in a collision. Please choose the deductible you would like for Collision coverage. The deductible is the amount you are responsible to pay in the event of a collision claim.
Comprehensive Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Comprehensive Coverage
Comprehensive coverage for the cost of repairing or replacing your vehicle up to the actual cash value if it's damaged by other unexpected situations such as falling or flying objects, vandalism, fire, theft or attempted theft, glass repair, a natural disaster, or a riot or civil disobedience less the deductible you choose.
Additional Coverages
- Replacement Rental Vehicle (SEF 20)
- Extend Coverage to a Rental Vehicle (SEF 27)
- Accident Waiver (SEF 39)
- Emergency Roadside Service Coverage - (SEF 35)
- Waiver of Depreciation Coverage (Brand New Vehicle Only) - (SEF 43R)
Please check any additional coverages you are interested in having included on your quote.
+ Add Vehicle
Vehicle 6
Year
Make
Model
Liability Coverage
- $500,000 Liability
- $1,000,000 Liability
- $2,000,000 Liability
Third Party Liability protects the insured Nova Scotia driver and/or the registered vehicle owner in the event they cause injury, death or property damage to a third-party resulting from the driver's negligence in operating the motor vehicle.
Collision Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Collision Coverage
Helps cover the cost of repairing or replacing your own vehicle if it's damaged in a collision. Please choose the deductible you would like for Collision coverage. The deductible is the amount you are responsible to pay in the event of a collision claim.
Comprehensive Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Comprehensive Coverage
Comprehensive coverage for the cost of repairing or replacing your vehicle up to the actual cash value if it's damaged by other unexpected situations such as falling or flying objects, vandalism, fire, theft or attempted theft, glass repair, a natural disaster, or a riot or civil disobedience less the deductible you choose.
Additional Coverages
- Replacement Rental Vehicle (SEF 20)
- Extend Coverage to a Rental Vehicle (SEF 27)
- Accident Waiver (SEF 39)
- Emergency Roadside Service Coverage - (SEF 35)
- Waiver of Depreciation Coverage (Brand New Vehicle Only) - (SEF 43R)
Please check any additional coverages you are interested in having included on your quote.
+ Add Vehicle
Vehicle 7
Year
Make
Model
Liability Coverage
- $500,000 Liability
- $1,000,000 Liability
- $2,000,000 Liability
Third Party Liability protects the insured Nova Scotia driver and/or the registered vehicle owner in the event they cause injury, death or property damage to a third-party resulting from the driver's negligence in operating the motor vehicle.
Collision Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Collision Coverage
Helps cover the cost of repairing or replacing your own vehicle if it's damaged in a collision. Please choose the deductible you would like for Collision coverage. The deductible is the amount you are responsible to pay in the event of a collision claim.
Comprehensive Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Comprehensive Coverage
Comprehensive coverage for the cost of repairing or replacing your vehicle up to the actual cash value if it's damaged by other unexpected situations such as falling or flying objects, vandalism, fire, theft or attempted theft, glass repair, a natural disaster, or a riot or civil disobedience less the deductible you choose.
Additional Coverages
- Replacement Rental Vehicle (SEF 20)
- Extend Coverage to a Rental Vehicle (SEF 27)
- Accident Waiver (SEF 39)
- Emergency Roadside Service Coverage - (SEF 35)
- Waiver of Depreciation Coverage (Brand New Vehicle Only) - (SEF 43R)
Please check any additional coverages you are interested in having included on your quote.
+ Add Vehicle
Vehicle 8
Year
Make
Model
Liability Coverage
- $500,000 Liability
- $1,000,000 Liability
- $2,000,000 Liability
Third Party Liability protects the insured Nova Scotia driver and/or the registered vehicle owner in the event they cause injury, death or property damage to a third-party resulting from the driver's negligence in operating the motor vehicle.
Collision Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Collision Coverage
Helps cover the cost of repairing or replacing your own vehicle if it's damaged in a collision. Please choose the deductible you would like for Collision coverage. The deductible is the amount you are responsible to pay in the event of a collision claim.
Comprehensive Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Comprehensive Coverage
Comprehensive coverage for the cost of repairing or replacing your vehicle up to the actual cash value if it's damaged by other unexpected situations such as falling or flying objects, vandalism, fire, theft or attempted theft, glass repair, a natural disaster, or a riot or civil disobedience less the deductible you choose.
Additional Coverages
- Replacement Rental Vehicle (SEF 20)
- Extend Coverage to a Rental Vehicle (SEF 27)
- Accident Waiver (SEF 39)
- Emergency Roadside Service Coverage - (SEF 35)
- Waiver of Depreciation Coverage (Brand New Vehicle Only) - (SEF 43R)
Please check any additional coverages you are interested in having included on your quote.
+ Add Vehicle
Vehicle 9
Year
Make
Model
Liability Coverage
- $500,000 Liability
- $1,000,000 Liability
- $2,000,000 Liability
Third Party Liability protects the insured Nova Scotia driver and/or the registered vehicle owner in the event they cause injury, death or property damage to a third-party resulting from the driver's negligence in operating the motor vehicle.
Collision Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Collision Coverage
Helps cover the cost of repairing or replacing your own vehicle if it's damaged in a collision. Please choose the deductible you would like for Collision coverage. The deductible is the amount you are responsible to pay in the event of a collision claim.
Comprehensive Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Comprehensive Coverage
Comprehensive coverage for the cost of repairing or replacing your vehicle up to the actual cash value if it's damaged by other unexpected situations such as falling or flying objects, vandalism, fire, theft or attempted theft, glass repair, a natural disaster, or a riot or civil disobedience less the deductible you choose.
Additional Coverages
- Replacement Rental Vehicle (SEF 20)
- Extend Coverage to a Rental Vehicle (SEF 27)
- Accident Waiver (SEF 39)
- Emergency Roadside Service Coverage - (SEF 35)
- Waiver of Depreciation Coverage (Brand New Vehicle Only) - (SEF 43R)
Please check any additional coverages you are interested in having included on your quote.
+ Add Vehicle
Vehicle 10
Year
Make
Model
Liability Coverage
- $500,000 Liability
- $1,000,000 Liability
- $2,000,000 Liability
Third Party Liability protects the insured Nova Scotia driver and/or the registered vehicle owner in the event they cause injury, death or property damage to a third-party resulting from the driver's negligence in operating the motor vehicle.
Collision Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Collision Coverage
Helps cover the cost of repairing or replacing your own vehicle if it's damaged in a collision. Please choose the deductible you would like for Collision coverage. The deductible is the amount you are responsible to pay in the event of a collision claim.
Comprehensive Coverage
- $250 Deductible
- $500 Deductible
- $1000 Deductible
- No Comprehensive Coverage
Comprehensive coverage for the cost of repairing or replacing your vehicle up to the actual cash value if it's damaged by other unexpected situations such as falling or flying objects, vandalism, fire, theft or attempted theft, glass repair, a natural disaster, or a riot or civil disobedience less the deductible you choose.
Additional Coverages
- Replacement Rental Vehicle (SEF 20)
- Extend Coverage to a Rental Vehicle (SEF 27)
- Accident Waiver (SEF 39)
- Emergency Roadside Service Coverage - (SEF 35)
- Waiver of Depreciation Coverage (Brand New Vehicle Only) - (SEF 43R)
Please check any additional coverages you are interested in having included on your quote.

Driver Information
Driver 1
Name*
First Name Last Name
Date of Birth*
Driver's License Master Number

A driver's license number is required in orer for us to run the driving and insurance history reports required to finalize a quote. We will be able to provide a quote much faster if drivers license numbers are provided for each driver.
+ Add Driver
Driver 2
Name
First Name Last Name
Date of Birth
Driver's License Master Number
+ Add Driver
Driver 3
Name
First Name Last Name
Date of Birth
Driver's License Master Number
+ Add Driver
Driver 4
Name
First Name Last Name
Date of Birth
Driver's License Master Number
+ Add Driver
Driver 5
Name
First Name Last Name
Date of Birth
Driver's License Master Number
+ Add Driver
Driver 6
Name
First Name Last Name
Date of Birth
Driver's License Master Number
+ Add Driver
Driver 7
Name
First Name Last Name
Date of Birth
Driver's License Master Number
+ Add Driver
Driver 8
Name
First Name Last Name
Date of Birth
Driver's License Master Number
+ Add Driver
Driver 9
Name
First Name Last Name
Date of Birth
Driver's License Master Number
+ Add Driver
Driver 10
Name
First Name Last Name
Date of Birth
Driver's License Master Number

Discount Information
Snow Tire Discount
Does your vehicle have snow tires?*
- Yes
- No
Private Parking Discount
Does your residence have private parking?*
- Yes
- No
Your Occupation
What is your occupation?
Credit Score Discount
Do you consent to a soft credit check to determine if you’re eligible for a credit-based discount (up to 30% savings)?*
- Yes
- No
Some of the insurance companies we work with are now offering discounts based on soft credit check results. This does not impact your credit score, and we don't see your credit information, the system just determines the discounts available.
Do you agree with our credit consent statement?*
- For the purposes of providing insurance quotations, completing applications, issuing new policies or subsequent renewals or change in coverage and payment thereof, I authorize Cheep Insurance and/or its insurance suppliers, on behalf of myself and other applicants/policyholders listed to collect, use and disclose personal information, including relevant reports containing policy and claim history up to 25 years and credit information, such as my credit score, as applicable to the insurance company supplier, for the purposes of assessing, managing and underwriting risk, determining a premium, establishing eligibility for a premium payment plan (as applicable), investigating and settling claims, analyzing business results, detecting and preventing fraud as permitted by law and in accordance with its privacy policies. I understand that Cheep Insurance is gathering this consent on behalf of multiple insurance companies and that I can withdraw my consent at any time.
For the purposes of providing insurance quotations, completing applications, issuing new policies or subsequent renewals or change in coverage and payment thereof, I authorize Cheep Insurance and/or its insurance suppliers, on behalf of myself and other applicants/policyholders listed to collect, use and disclose personal information, including relevant reports containing policy and claim history up to 25 years and credit information, such as my credit score, as applicable to the insurance company supplier, for the purposes of assessing, managing and underwriting risk, determining a premium, establishing eligibility for a premium payment plan (as applicable), investigating and settling claims, analyzing business results, detecting and preventing fraud as permitted by law and in accordance with its privacy policies. I understand that Cheep Insurance is gathering this consent on behalf of multiple insurance companies and that I can withdraw my consent at any time.
Stability of Residence Discount
For how long have you lived at your current residence (up to 5% savings)?*
- Less than 1 year
- 1 to 3 years
- More than 3 years
Some companies offer discounts if you’ve lived at your current residence for a certain number of years.
Usage Based Driving Program Discount
Would you like us to include telematics program options when we compare quotes for you (up to 30% savings)?*
- Yes
- No
Some companies offer discounts based on your driving habits through “telematics programs”. If you enrol in one of these programs, you get a 10-15% discount on your car insurance for the first 6 months to a year, you install a device in your car to monitor your driving habits, and you can receive additional discounts based on those habits.
Bundle & Save
You can save up to 15% on each of your insurance policies by bundling them with the same company. Would you like us to put together quotes for any of the following insurance products to see if we can save you some money?
- Home
- Tenant
- Boat
- Travel Trailer
- Cottage
- Recreational Vehicle (ATV, Snowmobile, etc)

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How did you hear about Cheep Insurance?
Referral contest info (optional)
We have a sweet referral program where we give away gift cards every month. Enter the name and contact info for the person who referred you here & we'll enter both you and them into our upcoming contest draws! 🙂

Visit our website for full Contest Rules
Name of person who referred you
Email address of person who referred you
Phone number of person who referred you
Which car dealership referred you?
Which insurance company or brokerage told you about us?

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