Refer me

We would be happy to contact you to answer questions and provide you with information. All you need to do is complete the following form. For security and confidentiality reasons, take care not to enter any personal information other than that which is requested.

The form contains errors.
The fields containing errors are indicated in red, and the error messages are adapted to the fields in question.

Your entry has been saved. Thank you for the trust you have placed in us.

Fields marked with (*) are mandatory.

I’d like to refer your services to:

Ms. Mr.

First name *

Last name*

Telephone *

Type of insurance *

Please indicate the date and time at which we should call this person *

a.m.

p.m.

evening

weekend

I don’t know

Referred by:

First name*

Last name*

Relationship to the person you are referring *

Comments

The information provided will be used to follow up on the contact request. A damaged insurance agent will contact this person to complete an insurance quote based on his or her needs and to offer competitive rates.

Contact Information

Assurances Sylvie Chandonnet inc.

Damage Insurance Agency

772 Monique-Dupont St
Trois-Rivières QC
G8W 0M8

819 840-2013
1 866 708-1004

Email us

Claims

1 855 747-7711

Roadside Assistance

1 866 833-0333