My 360°

Client Protection Review

Introduce your client for a complimentary Insurance and Risk Management Review in under two minutes. A licensed mybrokers.ca advisor is assigned automatically, contacts your client directly, and keeps you in the loop on the file.

Client Authorization & Disclosure

I confirm that:

I have obtained my client's consent to share their contact and property information with mybrokers.ca.
I have explained that mybrokers.ca is an independent insurance brokerage and is not owned or operated by MaxWell Realty Inc. or the participating brokerage.
My client understands that participation is completely voluntary and they are free to obtain insurance through any insurer or broker of their choosing.
My client has authorized mybrokers.ca to contact them by telephone and/or email regarding insurance quotations, insurance products, and risk management services.
I have disclosed any applicable business relationship between my brokerage and mybrokers.ca in accordance with applicable regulatory requirements.

Client details

The homebuyer we will be quoting.

First name *

Last name *

Email *

Phone *

Current mailing address *

Property to insure

Address is required. The rest helps us prepare a faster, sharper quote.

The property to insure is the same as the client's mailing address

Property address *

Year built

Square footage

Type of dwelling

Referring REALTOR®

So we can keep you in the loop on your client's file.

REALTOR® name *

Email *

Phone *

Participating brokerage *

Submit Client Introduction

Upon submission, a licensed mybrokers.ca Insurance Advisor will contact your client directly to arrange their complimentary Insurance & Risk Management Review.

The referring REALTOR® will receive updates regarding the status of the introduction, where appropriate.

Fields marked * are required.

Privacy & Disclaimer

This form authorizes the introduction of a client to mybrokers.cafor the purpose of arranging a complimentary Insurance & Risk Management Review.

Personal information will be collected, used, and disclosed by mybrokers.ca in accordance with applicable privacy legislation and solely for the purposes authorized by the client.

Insurance advice, insurance quotations, and insurance products are provided exclusively by licensed insurance professionals of mybrokers.ca.

Submission of this form does not obligate the client to purchase any insurance product, and clients remain free to obtain insurance through any provider of their choice.