Inbound Lead Distribution Form

Please submit your lead for the Alberta, British Columbia, and Ontario new business teams here.

This form is for reception teams, Business Development Managers, and all other employees submitting net new clients (calls, emails, or walk-ins). It also applies to:

• Existing personal insurance clients needing CGL or commercial auto
• Existing commercial clients needing home and/or auto
• Existing commercial clients requiring a new line of business not held in the past 12 months

If you are looking to make a referral, please visit Maple.

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Name *

First

Last

Please provide the client’s name.

Email *

Phone

Please select the category of insurance: *PersonalCommercialGroup Benefits

Please select the personal insurance product: *Car InsuranceLuxury Car InsuranceCollector Car InsuranceMotorcycle InsuranceBoat InsuranceOff-Road Vehicle InsuranceRV, Motorhome & Trailer InsuranceHome InsuranceCondo InsuranceTenant InsuranceCourse of ConstructionLuxury Home InsuranceStrata Deductible InsuranceEquine InsuranceFarm InsuranceFirearmCyber InsurancePet InsuranceInvestment PropertyInternational PropertySeasonal PropertyValuables & Collectibles

Please select the commercial insurance industry: *AgricultureAuto DealershipAviationConstructionEducationEnergy, Oil & GasEnvironmentalEquine BusinessFinancial ServicesFine Art & JewelleryFirearmsForestryHealthcareHospitalityManufacturingNon-ProfitReal EstateSmall BusinessTechnologyTransportationOther

Please select the commercial insurance product(s): *

• Not sure
• Bonding & Surety
• Commercial Auto
• Commercial General Liability
• Commercial Property
• Hole in One/Special Events
• Professional Liability/E&O Insurance

Please select the benefits product: *Group BenefitsGroup Savings & RetirementKey Person InsuranceCritical Illness InsuranceDisability InsuranceLife Insurance

Company Name

Annual Revenue0-1,000.0001,000,001 – 2,500,0002,500,001 – 5,000,0005,000,001 – 10,000,00010,000,001 – 20,000,00020,000,001+

Number of Employees1-56-1011-2021-5051-100101+

Select a location: *CalgaryEdmontonFort McMurrayRed DeerStettlerSylvan LakeBramptonOttawaRichmond HillBC Greater VancouverBC InteriorBC Island

Client Type – New, Existing, BDM or Monoline *New ClientBusiness Development ManagerExisting Client HomeExisting Client AutoExisting Client Business

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

Please provide your name: *

Description of Client Inquiry

Submit