Arrange Auto Renewal Insurance Online

Complete the form below using the information from your Insurance Registration

Contact Information

DCID Number:

Email:

Home Phone:

Work Phone:

Cell Phone:

License Plate Number:

Registration Number:

Expiry Date:

Delivery Information

Please enter the address information, time, and date to have your new decals delivered.

Address:

City:

Postal Code:

Delivery Date:

Delivery Time Between:

Additional Information

Notes:

What is DCID?

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Important

By ticking this box, I expect to receive a call within 2 business hours to confirm my requested appointment as well to review my coverage needs and preferred payment. Should I not receive a call within 2 business hours I understand the onus is on me to make contact with Rand and Fowler Insurance by phone at any one of our offices to re-confirm my request.

In all cases, I agree & understand my insurance is NOT renewed and my coverage will NOT take effect until a licensed insurance representative has met with me in person, sighted my identification and has collected premium for my policy.

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