Online Appointment Request for Quotation

Please fill out this short form and, an insurance broker from Les Assurances Marcel Godin & Fils inc. will contact you within 4 heures following the sending of your request. You may also tell us the day and time you would like to be called, according to our regular opening hours.

Opening hours:
From 8:00 a.m. to 5:00 p.m., Monday through Friday

* Last name:

* First name:

* Phone number:		(xxx-xxx-xxxx)

* E-mail:

* Postal code:		(A1A-1A1)

* Gender:		Male Female

Renewal date - car insurance:

Renewal date - home insurance:

Please mention if you want to be contacted at a specific moment:

Time:

Day: (Monday to Friday)

Questions or comments:


Are you a CAA-Quebec member ? Yes

* (Fields required)

By completing and submitting this form you agree to be contacted by phone, email or other methods by Les Assurances Marcel Godin & Fils inc. for the purposes of promoting their products and services to you and/or providing you with an insurance quote.