Contact Information

DCID Number: what is DCID?

Name:

Email:

Home Phone:

Work Phone:

Cell Phone:

License Plate Number:

Registration Number:

Expiry Date: ---12345678910111213141516171819202122232425262728293031 ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember ---201020112012201320142015

Delivery Information

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

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Delivery Time: between ---9:00AM9:30AM10:00AM10:30AM11:00AM11:30AM12:00PM12:30PM1:00PM1:30PM2:00PM2:30PM3:00PM3:30PM4:00PM4:30PM5:00PM5:30PM6:00PM6:30PM7:00PM7:30PM8:00PM8:30PM9:00PM and ---9:30AM10:00AM10:30AM11:00AM11:30AM12:00PM12:30PM1:00PM1:30PM2:00PM2:30PM3:00PM3:30PM4:00PM4:30PM5:00PM5:30PM6:00PM6:30PM7:00PM7:30PM8:00PM8:30PM9:00PM9:30PM

Additional Information

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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 Meier & Company Insurance by phone at 604-777-9999 or 1-888-989-2133 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.