Online Appointment Request for Quotation

Please fill out this short form and, an insurance broker from Favreau & Gendron, Mailloux & Rochon, Chevrier & Laporte and Delorme & Duquette will contact you within 2 hours 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:

Monday :	8:30 a.m. to 7:30 p.m.
Tuesday :	8:30 a.m. to 7:30 p.m.
Wednesday :	8:30 a.m. to 7:30 p.m.
Thursday :	8:30 a.m. to 7:30 p.m.
Friday :	8:30 a.m. to 4:30 p.m.

* 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 Favreau & Gendron, Mailloux & Rochon, Chevrier & Laporte and Delorme & Duquette for the purposes of promoting their products and services to you and/or providing you with an insurance quote.