Chamber of Commerce - Exclusive Employee Insurance Program First Name Last Name Company Insurance type Assurance auto Date de renouvellement (optional) Assurance habitation Date de renouvellement (optional) Résidence secondaire ou saisonnière Date de renouvellement (optional) Assurance véhicules récréatifs Date de renouvellement (optional) Assurance bateau Date de renouvellement (optional) Assurance-titre Date de renouvellement (optional) Autre(s) Autre(s), précisez (optional) Phone Number Email How would you like to be contacted? Phone Call Email When would you like to be contacted? ASAP Book a time What day would you like us to contact you? Monday Tuesday Wednesday Thursday Friday Time preference (optional) Morning (8:30 AM – 12:00 PM) Afternoon (12:00 PM – 5:00 PM) Additional Information / Comments: (optional) Want to get service directly? Skip the form and call 1 833 980-2568
