Contact an insurance broker

Certain Blue Cross products are available only through a licensed insurance broker.

Please complete the form below; an authorized broker will contact you with information on our products and services:

(*) The fields with an asterisk must be completed.

First name *

Last name *

Email *

Birthday *

Address

Address *

City *

Postal Code *

Province *

Telephone *

Extension no.

Other telephone

Extension no.

Please indicate the best time to contact you:

Day

Evening

I am interested in information on the following insurance products: *

Accident insurance

Critical illness insurance

Disability insurance

Life insurance

Long-term care insurance

Mortgage insurance

Other insurance products (please specify in the comments/questions box)

Other Comments / Questions