Reception Form

Please submit your lead for the Alberta and Ontario new business teams here. This form is for reception teams and business development managers to submit new business calls, emails and walk-ins. If you are looking to make a referral, please visit Maple.

Please enable JavaScript in your browser to complete this form.

Name

First

Last

Please provide the client’s name.

Phone

Please select the category of insurance:

Select a location:

Client Type – New, Existing, BDM or Monoline

If existing client please ensure it does not qualify for referral program before submitting.

Additional Comments