Auto Quote Tenant Quote Life Quote Get a Quote NowHomeowner's Quote RequestGet a Quote - Home Stepped Have you had any cancellations, claims, or gaps in insurance? * Yes NoPlease Contact Us Before Filling Out The Form.To ensure we find the best possible options for you, please contact our staff by either emailing us or calling our office before finishing the form.Toll Free Nova Scotia: 1 866 466 9660Toll Free Prince Edward Island: 1 866 312 4242Emailinfo@cluettinsurance.ca Email * Name * Address * Address Address Address City City Province Province Postal Postal Phone * Date of Birth Effective Date As your broker, I am gathering this consent on behalf of the insurer who advises me that: in respect of this quotation/application, any policy we issue and subsequent renewals or changes, we may collect, use, and disclose personal information reports including policy history, claims history, investigative information, rating information, risk information and only with respect to you, your personal credit information including credit score, as permitted by law and in accordance with our privacy policies.Do you, and on behalf of others listed, authorize use to collect, use and disclose to appropriate third parties, including your broker, this information solely relating to your personal property policy for the purposes necessary to assess the risk, determine a premium, determine eligibility and conditions for a premium payment plan, investigate and settile claims, analyze business results and detect and prevent fraud?Do you agree with the following consent statement? * Yes No If you are human, leave this field blank. Next
