{"id":160,"date":"2020-11-07T18:02:55","date_gmt":"2020-11-07T18:02:55","guid":{"rendered":"https:\/\/albertainsurance.agency\/?page_id=160"},"modified":"2020-11-10T02:24:36","modified_gmt":"2020-11-10T02:24:36","slug":"get-a-quote-for-your-auto-insurance","status":"publish","type":"page","link":"https:\/\/albertainsurance.agency\/?page_id=160","title":{"rendered":"Get a Quote for your Auto Insurance"},"content":{"rendered":"<p><b>If there will be more than one driver we need all drivers information.<br \/>\n<\/b><b>Let us know if they have their own policy.<\/b><\/p>\n<p>If you have 2nd car to insure or if there is secondary driver, please fill all applicable fields in the form below.\u00a0 Otherwise fill only required fields.<\/p>\n<p><em>Note: If you prefer you can download <a href=\"https:\/\/albertainsurance.agency\/wp-content\/uploads\/2020\/11\/AUTO-INFO-LIST.pdf-Fillable-1.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">application form in PDF format<\/a>, fill it and send it back to us by email.<\/em><\/p>\n<p><strong><span style=\"color: #ff0000;\">We will provide you with our best quote within 2 business days.<\/span><\/strong><\/p>\n<hr \/>\n<p><span style=\"font-size: 14pt;\">In order to provide you best rate for your car insurance please provide all required information when filling the form below:<br \/>\n<span style=\"font-size: 12pt;\"><em>Please fill this online form <\/em><em>( all required fields are marked with *)<\/em><\/span><br \/>\n<\/span><\/p>\n<p style=\"text-align: center;\"><div style=\"display:none\" class=\"fm-form-container fm-theme0\"><div id=\"fm-pages5\" class=\"fm-pages wdform_page_navigation \" show_title=\"\" show_numbers=\"1\" type=\"none\"><\/div><form name=\"form5\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F160\" method=\"post\" id=\"form5\" class=\"fm-form form5  \" enctype=\"multipart\/form-data\"><input type=\"hidden\" id=\"counter5\" value=\"64\" name=\"counter5\" \/><input type=\"hidden\" id=\"Itemid5\" value=\"\" name=\"Itemid5\" \/><input type=\"hidden\" id=\"fm_shake5\" value=\"1\" name=\"fm_shake5\" \/><input type=\"text\" class=\"fm-hide\" id=\"fm_empty_field_validation5\" value=\"\" name=\"fm_empty_field_validation5\" data-value=\"bd736efb144d599cf463541431fbf5c4\" \/><div class=\"wdform-page-and-images fm-form-builder\"><div id=\"5form_view1\" class=\"wdform_page\" page_title=\"Untitled page\" next_title=\"Next\" next_type=\"text\" next_class=\"wdform-page-button\" next_checkable=\"true\" previous_title=\"Previous\" previous_type=\"text\" previous_class=\"wdform-page-button\" previous_checkable=\"false\"><div class=\"wdform_section fm-row-deleting\"><div class=\"wdform_column\"><div wdid=\"2\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_name\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-row\">    <label  for=\"wdform_2_element_first5\" class=\"wdform-label\">PRIMARY DRIVER\/APPLICANT<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-100\" ><div class=\"wd-flex wd-flex-column wd-width-50\"><input type=\"text\" class=\"wd-width-100\" id=\"wdform_2_element_first5\" name=\"wdform_2_element_first5\" value=\"\" title=\"\" placeholder=\"\"  \/><label class=\"mini_label\" for=\"wdform_2_element_first5\">First Name<\/label><\/div><div class=\"wd-flex wd-flex-column wd-name-separator\"><\/div><div class=\"wd-flex wd-flex-column wd-width-50\"><input type=\"text\" class=\"wd-width-100\" id=\"wdform_2_element_last5\" name=\"wdform_2_element_last5\" value=\"\" title=\"\" placeholder=\"\"  \/><label class=\"mini_label\" for=\"wdform_2_element_last5\">Last Name<\/label><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"47\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_phone_new\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_47_element5\" class=\"wdform-label\">Primary Driver: Phone Number<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><input type=\"text\"                       class=\"wd-width-100\"                       id=\"wdform_47_element5\"                       name=\"wdform_47_element5\"                       value=\"\"                       placeholder=\"\"  \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"48\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_submitter_mail\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-row\">    <label  for=\"wdform_48_element5\" class=\"wdform-label\">Primary Driver Email<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-100\" ><input type=\"text\" class=\"wd-width-100\" id=\"wdform_48_element5\" name=\"wdform_48_element5\" value=\"\" title=\"\" placeholder=\"\"   onchange=\"wd_check_email('48', '5', 'This is not a valid email address.')\" \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"15\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_date_fields\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100 wdform_date_fields wd-flex-row\">    <label  for=\"wdform_15_day5\" class=\"wdform-label\">Primary Driver - Date of Birth<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex wdform_date_fields wd-flex-row wd-width-100\" ><div class=\"wd-flex wd-flex-row wd-width-100 wd-align-items\"><div class=\"wd-flex wd-flex-column\"><select id=\"wdform_15_day5\" name=\"wdform_15_day5\" style=\"width: 60px;\" ><option value=\"\"><\/option><option value=\"01\" >01<\/option><option value=\"02\" >02<\/option><option value=\"03\" >03<\/option><option value=\"04\" >04<\/option><option value=\"05\" >05<\/option><option value=\"06\" >06<\/option><option value=\"07\" >07<\/option><option value=\"08\" >08<\/option><option value=\"09\" >09<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><label for=\"wdform_15_day5\" class=\"mini_label\">day<\/label><\/div><span class=\"wdform_separator\">&nbsp;\/&nbsp;<\/span><div class=\"wd-flex wd-flex-column\"><select id=\"wdform_15_month5\" name=\"wdform_15_month5\" style=\"width: 100px;\" ><option value=\"\"><\/option><option value=\"01\"   >January<\/option><option value=\"02\" >February<\/option><option value=\"03\" >March<\/option><option value=\"04\"  >April<\/option><option value=\"05\"  >May<\/option><option value=\"06\"  >June<\/option><option value=\"07\"  >July<\/option><option value=\"08\"  >August<\/option><option value=\"09\"  >September<\/option><option value=\"10\"  >October<\/option><option value=\"11\" >November<\/option><option value=\"12\"  >December<\/option><\/select><label for=\"wdform_15_month5\" class=\"mini_label\">month<\/label><\/div><span class=\"wdform_separator\">&nbsp;\/&nbsp;<\/span><div class=\"wd-flex wd-flex-column\"><select id=\"wdform_15_year5\" name=\"wdform_15_year5\"  from=\"1901\" to=\"2020\" style=\"width: 80px;\" ><option value=\"\"><\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><option value=\"1919\" >1919<\/option><option value=\"1918\" >1918<\/option><option value=\"1917\" >1917<\/option><option value=\"1916\" >1916<\/option><option value=\"1915\" >1915<\/option><option value=\"1914\" >1914<\/option><option value=\"1913\" >1913<\/option><option value=\"1912\" >1912<\/option><option value=\"1911\" >1911<\/option><option value=\"1910\" >1910<\/option><option value=\"1909\" >1909<\/option><option value=\"1908\" >1908<\/option><option value=\"1907\" >1907<\/option><option value=\"1906\" >1906<\/option><option value=\"1905\" >1905<\/option><option value=\"1904\" >1904<\/option><option value=\"1903\" >1903<\/option><option value=\"1902\" >1902<\/option><option value=\"1901\" >1901<\/option><\/select><label for=\"wdform_15_year5\" class=\"mini_label\">year<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"39\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Your Gender<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_39_element5\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_39_element50\" name=\"wdform_39_element5\" value=\"Male\" onclick=\"set_default(&quot;wdform_39&quot;,&quot;0&quot;,&quot;5&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_39_element50\"><span><\/span>Male<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_39_element51\" name=\"wdform_39_element5\" value=\"Female\" onclick=\"set_default(&quot;wdform_39&quot;,&quot;1&quot;,&quot;5&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_39_element51\"><span><\/span>Female<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"62\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Marital Status<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_62_element5\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_62_element50\" name=\"wdform_62_element5\" value=\"Married\" onclick=\"set_default(&quot;wdform_62&quot;,&quot;0&quot;,&quot;5&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_62_element50\"><span><\/span>Married<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_62_element51\" name=\"wdform_62_element5\" value=\"Not Married\" onclick=\"set_default(&quot;wdform_62&quot;,&quot;1&quot;,&quot;5&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_62_element51\"><span><\/span>Not Married<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"9\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_address\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100 wdform_address wd-flex-column\">    <label  for=\"wdform_9_street15\" class=\"wdform-label\">ADDRESS<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex wdform_address wd-flex-column wd-width-100\" ><span class=\"wd-width-100 wd-address\">                <input class=\"wd-width-100\" type=\"text\" id=\"wdform_9_street15\" name=\"wdform_9_street15\" value=\"\"  \/>                <label for=\"wdform_9_street15\" class=\"mini_label\">Street Address<\/label><\/span><span class=\"wd-width-100 wd-flex wd-flex-row wd-flex-wrap wd-justify-content\"><span class=\"wd-width-49 wd-address\">                <input class=\"wd-width-100\" type=\"text\" id=\"wdform_9_city5\" name=\"wdform_11_city5\" value=\"\"  \/>                <label for=\"wdform_9_city5\" class=\"mini_label\">City<\/label><\/span><span class=\"wd-width-49 wd-address\">                <input class=\"wd-width-100\" type=\"text\" id=\"wdform_9_state5\" name=\"wdform_12_state5\" value=\"\"  \/>                <label for=\"wdform_9_state5\" class=\"mini_label\">State \/ Province \/ Region<\/label><\/span><span class=\"wd-width-49 wd-address\">              <input class=\"wd-width-100\" type=\"text\" id=\"wdform_9_postal5\" name=\"wdform_13_postal5\" value=\"\"  \/>              <label for=\"wdform_9_postal5\" class=\"mini_label\">Postal \/ Zip Code<\/label><\/span><\/span><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"36\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_36_element5\" class=\"wdform-label\">Do you own or rent your home?<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_36_element5\"                           name=\"wdform_36_element5\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><div wdid=\"40\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_40_element5\" class=\"wdform-label\">Your Occupation<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_40_element5\"                           name=\"wdform_40_element5\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"38\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100 undefined wd-flex-row wd-align-items-center\">    <label  for=\"wdform_38_element5\" class=\"wdform-label\">Did you complete a driver education course?<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex undefined wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_38_element5\"                           name=\"wdform_38_element5\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"50\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_50_element5\" class=\"wdform-label\">When does your current policy expire?<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_50_element5\"                           name=\"wdform_50_element5\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><div wdid=\"51\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_51_element5\" class=\"wdform-label\"># of years of  continuous insurance in Canada<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_51_element5\"                           name=\"wdform_51_element5\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"52\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_52_element5\" class=\"wdform-label\">Primary Driver: Driver's Licence number<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" style=\"max-width: 200px;\"><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_52_element5\"                           name=\"wdform_52_element5\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"43\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_spinner\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-row\">    <label  for=\"wdform_43_element5\" class=\"wdform-label\">Primary Driver: # of tickets (within last 3 years) after being pulled over?<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-100\" ><input                            name=\"wdform_43_element5\"                            id=\"wdform_43_element5\"                            class=\"wd-type-number\"                            onkeyup=\"wd_validate(this)\"                            data-valid-type=\"number\"                            data-form-id=\"5\"                            data-wdid=\"43\"                            style=\"width: 60px;\"                            value=\"0\"                             \/><\/div><\/div><\/div><div wdid=\"44\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_spinner\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-row\">    <label  for=\"wdform_44_element5\" class=\"wdform-label\">Primary Driver: # of claims at-fault within the last 6 years<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-100\" ><input                            name=\"wdform_44_element5\"                            id=\"wdform_44_element5\"                            class=\"wd-type-number\"                            onkeyup=\"wd_validate(this)\"                            data-valid-type=\"number\"                            data-form-id=\"5\"                            data-wdid=\"44\"                            style=\"width: 60px;\"                            value=\"0\"                             \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"28\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_editor\" class=\"wdform-field\"><hr style=\"height: 3px; border-width: 0; color: white;\" data-mce-style=\"height: 3px; border-width: 0; color: white;\"><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"22\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_name\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-row\">    <label  for=\"wdform_22_element_first5\" class=\"wdform-label\">Second Driver ( if applicable )<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-100\" ><div class=\"wd-flex wd-flex-column wd-width-50\"><input type=\"text\" class=\"wd-width-100\" id=\"wdform_22_element_first5\" name=\"wdform_22_element_first5\" value=\"\" title=\"\" placeholder=\"\"  \/><label class=\"mini_label\" for=\"wdform_22_element_first5\">First Name<\/label><\/div><div class=\"wd-flex wd-flex-column wd-name-separator\"><\/div><div class=\"wd-flex wd-flex-column wd-width-50\"><input type=\"text\" class=\"wd-width-100\" id=\"wdform_22_element_last5\" name=\"wdform_22_element_last5\" value=\"\" title=\"\" placeholder=\"\"  \/><label class=\"mini_label\" for=\"wdform_22_element_last5\">Last Name<\/label><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"63\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_phone_new\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_63_element5\" class=\"wdform-label\">Second Driver: Phone Number<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><input type=\"text\"                       class=\"wd-width-100\"                       id=\"wdform_63_element5\"                       name=\"wdform_63_element5\"                       value=\"\"                       placeholder=\"\"  \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"23\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_date_fields\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100 wdform_date_fields wd-flex-row\">    <label  for=\"wdform_23_day5\" class=\"wdform-label\">Second Driver - Date of Birth<\/label><\/div><div class=\"wdform-element-section wd-flex wdform_date_fields wd-flex-row wd-width-100\" ><div class=\"wd-flex wd-flex-row wd-width-100 wd-align-items\"><div class=\"wd-flex wd-flex-column\"><select id=\"wdform_23_day5\" name=\"wdform_23_day5\" style=\"width: 60px;\" ><option value=\"\"><\/option><option value=\"01\" >01<\/option><option value=\"02\" >02<\/option><option value=\"03\" >03<\/option><option value=\"04\" >04<\/option><option value=\"05\" >05<\/option><option value=\"06\" >06<\/option><option value=\"07\" >07<\/option><option value=\"08\" >08<\/option><option value=\"09\" >09<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><label for=\"wdform_23_day5\" class=\"mini_label\">day<\/label><\/div><span class=\"wdform_separator\">&nbsp;\/&nbsp;<\/span><div class=\"wd-flex wd-flex-column\"><select id=\"wdform_23_month5\" name=\"wdform_23_month5\" style=\"width: 100px;\" ><option value=\"\"><\/option><option value=\"01\"   >January<\/option><option value=\"02\" >February<\/option><option value=\"03\" >March<\/option><option value=\"04\"  >April<\/option><option value=\"05\"  >May<\/option><option value=\"06\"  >June<\/option><option value=\"07\"  >July<\/option><option value=\"08\"  >August<\/option><option value=\"09\"  >September<\/option><option value=\"10\"  >October<\/option><option value=\"11\" >November<\/option><option value=\"12\"  >December<\/option><\/select><label for=\"wdform_23_month5\" class=\"mini_label\">month<\/label><\/div><span class=\"wdform_separator\">&nbsp;\/&nbsp;<\/span><div class=\"wd-flex wd-flex-column\"><select id=\"wdform_23_year5\" name=\"wdform_23_year5\"  from=\"1901\" to=\"2020\" style=\"width: 80px;\" ><option value=\"\"><\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><option value=\"1919\" >1919<\/option><option value=\"1918\" >1918<\/option><option value=\"1917\" >1917<\/option><option value=\"1916\" >1916<\/option><option value=\"1915\" >1915<\/option><option value=\"1914\" >1914<\/option><option value=\"1913\" >1913<\/option><option value=\"1912\" >1912<\/option><option value=\"1911\" >1911<\/option><option value=\"1910\" >1910<\/option><option value=\"1909\" >1909<\/option><option value=\"1908\" >1908<\/option><option value=\"1907\" >1907<\/option><option value=\"1906\" >1906<\/option><option value=\"1905\" >1905<\/option><option value=\"1904\" >1904<\/option><option value=\"1903\" >1903<\/option><option value=\"1902\" >1902<\/option><option value=\"1901\" >1901<\/option><\/select><label for=\"wdform_23_year5\" class=\"mini_label\">year<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"41\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Second Driver: Gender<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_41_element5\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_41_element50\" name=\"wdform_41_element5\" value=\"Male\" onclick=\"set_default(&quot;wdform_41&quot;,&quot;0&quot;,&quot;5&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_41_element50\"><span><\/span>Male<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_41_element51\" name=\"wdform_41_element5\" value=\"Female\" onclick=\"set_default(&quot;wdform_41&quot;,&quot;1&quot;,&quot;5&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_41_element51\"><span><\/span>Female<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"59\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Does the Second Driver have his\/her own auto insurance policy?<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_59_element5\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_59_element50\" name=\"wdform_59_element5\" value=\"Yes\" onclick=\"set_default(&quot;wdform_59&quot;,&quot;0&quot;,&quot;5&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_59_element50\"><span><\/span>Yes<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_59_element51\" name=\"wdform_59_element5\" value=\"No\" onclick=\"set_default(&quot;wdform_59&quot;,&quot;1&quot;,&quot;5&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_59_element51\"><span><\/span>No<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"42\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100 undefined wd-flex-row wd-align-items-center\">    <label  for=\"wdform_42_element5\" class=\"wdform-label\">Second Driver: Occupation<\/label><\/div><div class=\"wdform-element-section wd-flex undefined wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_42_element5\"                           name=\"wdform_42_element5\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"53\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_53_element5\" class=\"wdform-label\">Second Driver: Driver's Licence number<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" style=\"max-width: 200px;\"><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_53_element5\"                           name=\"wdform_53_element5\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><div wdid=\"54\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_54_element5\" class=\"wdform-label\"># of years of continuous insurance in Canada<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" style=\"max-width: 200px;\"><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_54_element5\"                           name=\"wdform_54_element5\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"46\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_spinner\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-row\">    <label  for=\"wdform_46_element5\" class=\"wdform-label\">Second Driver: # of claims at-fault within the last 6 years<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-100\" ><input                            name=\"wdform_46_element5\"                            id=\"wdform_46_element5\"                            class=\"wd-type-number\"                            onkeyup=\"wd_validate(this)\"                            data-valid-type=\"number\"                            data-form-id=\"5\"                            data-wdid=\"46\"                            style=\"width: 60px;\"                            value=\"0\"                             \/><\/div><\/div><\/div><div wdid=\"45\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_spinner\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-row\">    <label  for=\"wdform_45_element5\" class=\"wdform-label\">Second Driver: # of tickets (within last 3 years) after being pulled over?<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-100\" ><input                            name=\"wdform_45_element5\"                            id=\"wdform_45_element5\"                            class=\"wd-type-number\"                            onkeyup=\"wd_validate(this)\"                            data-valid-type=\"number\"                            data-form-id=\"5\"                            data-wdid=\"45\"                            style=\"width: 60px;\"                            value=\"0\"                             attribute=value \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"29\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_editor\" class=\"wdform-field\"><hr style=\"height: 3px; border-width: 0; color: white;\" data-mce-style=\"height: 3px; border-width: 0; color: white;\"><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"57\" class=\"wdform_row\"><div type=\"type_matrix\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100 wdform_matrix wd-flex-row\">    <label  class=\"wdform-label\">Primary Car Information<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex wdform_matrix wd-flex-row wd-width-100\" ><div id=\"wdform_57_element5\" class=\"wd-width-100 wdform-matrix-table\" ><div class=\"wd-table-group\"><div class=\"wdform-matrix-head\"><div class=\"wd-table-cell\"><\/div><div><label class=\"wdform-ch-rad-label\">Enter your answers:<\/label><\/div><\/div><div class=\"wdform-matrix-row1\" row=\"1\"><div class=\"wdform-matrix-column\"><label class=\"wdform-ch-rad-label\" > -   Make<\/label><\/div><div class=\"wdform-matrix-cell\"><input id=\"wdform_57_input_element51_1\" type=\"text\" name=\"wdform_57_input_element51_1\" value=\"\" style=\"width:200px\"><\/div><\/div><div class=\"wdform-matrix-row0\" row=\"2\"><div class=\"wdform-matrix-column\"><label class=\"wdform-ch-rad-label\" > -   Model<\/label><\/div><div class=\"wdform-matrix-cell\"><input id=\"wdform_57_input_element52_1\" type=\"text\" name=\"wdform_57_input_element52_1\" value=\"\" style=\"width:200px\"><\/div><\/div><div class=\"wdform-matrix-row1\" row=\"3\"><div class=\"wdform-matrix-column\"><label class=\"wdform-ch-rad-label\" > -   Year<\/label><\/div><div class=\"wdform-matrix-cell\"><input id=\"wdform_57_input_element53_1\" type=\"text\" name=\"wdform_57_input_element53_1\" value=\"\" style=\"width:200px\"><\/div><\/div><div class=\"wdform-matrix-row0\" row=\"4\"><div class=\"wdform-matrix-column\"><label class=\"wdform-ch-rad-label\" > -   Number of km commuting to work ( one way )<\/label><\/div><div class=\"wdform-matrix-cell\"><input id=\"wdform_57_input_element54_1\" type=\"text\" name=\"wdform_57_input_element54_1\" value=\"\" style=\"width:200px\"><\/div><\/div><\/div><input type=\"hidden\" name=\"wdform_57_element5\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"56\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_56_element5\" class=\"wdform-label\">Primary Car: VIN number ( type the number or n\/a )<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" style=\"max-width: 200px;\"><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_56_element5\"                           name=\"wdform_56_element5\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"49\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Do you need Full Coverage or Liability only?<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_49_element5\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_49_element50\" name=\"wdform_49_element5\" value=\"Full Coverage\" onclick=\"set_default(&quot;wdform_49&quot;,&quot;0&quot;,&quot;5&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_49_element50\"><span><\/span>Full Coverage<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_49_element51\" name=\"wdform_49_element5\" value=\"Liability only\" onclick=\"set_default(&quot;wdform_49&quot;,&quot;1&quot;,&quot;5&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_49_element51\"><span><\/span>Liability only<\/label><\/div><\/div><\/div><\/div><\/div><div wdid=\"33\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Is your car #1 paid off ?<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_33_element5\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_33_element50\" name=\"wdform_33_element5\" value=\"Yes\" onclick=\"set_default(&quot;wdform_33&quot;,&quot;0&quot;,&quot;5&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_33_element50\"><span><\/span>Yes<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_33_element51\" name=\"wdform_33_element5\" value=\"No\" onclick=\"set_default(&quot;wdform_33&quot;,&quot;1&quot;,&quot;5&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_33_element51\"><span><\/span>No<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"35\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_editor\" class=\"wdform-field\"><hr style=\"height: 3px; border-width: 0; color: white;\" data-mce-style=\"height: 3px; border-width: 0; color: white;\"><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"55\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_matrix\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100 wdform_matrix wd-flex-row\">    <label  class=\"wdform-label\">Second Car Information ( if applicable )<\/label><\/div><div class=\"wdform-element-section wd-flex wdform_matrix wd-flex-row wd-width-100\" ><div id=\"wdform_55_element5\" class=\"wd-width-100 wdform-matrix-table\" ><div class=\"wd-table-group\"><div class=\"wdform-matrix-head\"><div class=\"wd-table-cell\"><\/div><div><label class=\"wdform-ch-rad-label\">Enter your answers:<\/label><\/div><\/div><div class=\"wdform-matrix-row1\" row=\"1\"><div class=\"wdform-matrix-column\"><label class=\"wdform-ch-rad-label\" > -   Make<\/label><\/div><div class=\"wdform-matrix-cell\"><input id=\"wdform_55_input_element51_1\" type=\"text\" name=\"wdform_55_input_element51_1\" value=\"\" style=\"width:200px\"><\/div><\/div><div class=\"wdform-matrix-row0\" row=\"2\"><div class=\"wdform-matrix-column\"><label class=\"wdform-ch-rad-label\" > -   Model<\/label><\/div><div class=\"wdform-matrix-cell\"><input id=\"wdform_55_input_element52_1\" type=\"text\" name=\"wdform_55_input_element52_1\" value=\"\" style=\"width:200px\"><\/div><\/div><div class=\"wdform-matrix-row1\" row=\"3\"><div class=\"wdform-matrix-column\"><label class=\"wdform-ch-rad-label\" > -   Year<\/label><\/div><div class=\"wdform-matrix-cell\"><input id=\"wdform_55_input_element53_1\" type=\"text\" name=\"wdform_55_input_element53_1\" value=\"\" style=\"width:200px\"><\/div><\/div><div class=\"wdform-matrix-row0\" row=\"4\"><div class=\"wdform-matrix-column\"><label class=\"wdform-ch-rad-label\" > -   Number of km commuting to work ( one way )<\/label><\/div><div class=\"wdform-matrix-cell\"><input id=\"wdform_55_input_element54_1\" type=\"text\" name=\"wdform_55_input_element54_1\" value=\"\" style=\"width:200px\"><\/div><\/div><\/div><input type=\"hidden\" name=\"wdform_55_element5\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"58\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100 undefined wd-flex-row wd-align-items-center\">    <label  for=\"wdform_58_element5\" class=\"wdform-label\">Second Car: VIN number ( type the number or n\/a )<\/label><\/div><div class=\"wdform-element-section wd-flex undefined wd-flex-row wd-align-items-center wd-width-100\" style=\"max-width: 200px;\"><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_58_element5\"                           name=\"wdform_58_element5\"                           value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"61\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Do you need Full Coverage or Liability only? (2nd car)<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_61_element5\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_61_element50\" name=\"wdform_61_element5\" value=\"Full Coverage\" onclick=\"set_default(&quot;wdform_61&quot;,&quot;0&quot;,&quot;5&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_61_element50\"><span><\/span>Full Coverage<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_61_element51\" name=\"wdform_61_element5\" value=\"Liability only\" onclick=\"set_default(&quot;wdform_61&quot;,&quot;1&quot;,&quot;5&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_61_element51\"><span><\/span>Liability only<\/label><\/div><\/div><\/div><\/div><\/div><div wdid=\"34\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Is your car # 2 paid off ?<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_34_element5\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_34_element50\" name=\"wdform_34_element5\" value=\"Yes\" onclick=\"set_default(&quot;wdform_34&quot;,&quot;0&quot;,&quot;5&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element50\"><span><\/span>Yes<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_34_element51\" name=\"wdform_34_element5\" value=\"No\" onclick=\"set_default(&quot;wdform_34&quot;,&quot;1&quot;,&quot;5&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_34_element51\"><span><\/span>No<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"60\" class=\"wdform_row\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_60_element5\" class=\"wdform-label\">Additional Information ( (e.g more cars or drivers - please provide all details as above)<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><textarea class=\"wd-width-100\"                      id=\"wdform_60_element5\"                      name=\"wdform_60_element5\"                      placeholder=\"\"                      style=\"height: 100px;\"                      ><\/textarea><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"1\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_submit_reset\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column\"><div class=\"wdform-element-section wd-flex  wd-flex-row wd-justify-content-left wd-width-100\" ><button  type=\"button\" class=\"button-submit\" onclick=\"fm_submit_form('5');\"  data-ajax=\"0\"><span class=\"fm-submit-loading spinner fm-ico-spinner\"><\/span>Submit<\/button><button  type=\"button\" class=\"button-reset \" onclick=\"fm_reset_form(5);\" >Reset<\/button><\/div><\/div><\/div><\/div><\/div><div valign=\"top\" class=\"wdform_footer wd-width-100\" wfd-invisible=\"true\"><div class=\"wd-width-100\"><div class=\"wd-width-100 wd-table\" style=\"padding-top:10px;\"><div class=\"wd-table-group\"><div id=\"5page_nav1\" class=\"wd-table-row\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_preload\"><\/div><\/form><\/div><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>If there will be more than one driver we need all drivers information. Let us know if they have their own policy. If you have 2nd car to insure or if there is secondary driver, please fill all applicable fields in the form below.\u00a0 Otherwise fill only required fields. Note: If you prefer you can &hellip; <a href=\"https:\/\/albertainsurance.agency\/?page_id=160\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &#8220;Get a Quote for your Auto Insurance&#8221;<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-160","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/albertainsurance.agency\/index.php?rest_route=\/wp\/v2\/pages\/160","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/albertainsurance.agency\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/albertainsurance.agency\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/albertainsurance.agency\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/albertainsurance.agency\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=160"}],"version-history":[{"count":14,"href":"https:\/\/albertainsurance.agency\/index.php?rest_route=\/wp\/v2\/pages\/160\/revisions"}],"predecessor-version":[{"id":222,"href":"https:\/\/albertainsurance.agency\/index.php?rest_route=\/wp\/v2\/pages\/160\/revisions\/222"}],"wp:attachment":[{"href":"https:\/\/albertainsurance.agency\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=160"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}