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Submitted URL: https://engage.ca.victorinsurance.com/acton/ct/38839/s-03ef-2111/Bct/l-02a6/l-02a6:a2/ct3_0/1/lu?sid=TV2%3A7oP0hH5fQ
Effective URL: https://www.victorinsurance.ca/en/aboutus/contactus/general_inquiry.html?utm_term=click%20here&utm_campaign=Catherine,%20Constr...
Submission: On December 09 via api from US — Scanned from CA
Effective URL: https://www.victorinsurance.ca/en/aboutus/contactus/general_inquiry.html?utm_term=click%20here&utm_campaign=Catherine,%20Constr...
Submission: On December 09 via api from US — Scanned from CA
Form analysis
1 forms found in the DOMPOST /en/aboutus/contactus/general_inquiry/_jcr_content/rightcolpar/contactusform.contactus.html
<form action="/en/aboutus/contactus/general_inquiry/_jcr_content/rightcolpar/contactusform.contactus.html" method="POST" class="form-structure" id="contactUs" novalidate="novalidate">
<div class="row">
<div class="large-6 medium-6 small-12 columns">
<label for="firstName">First Name<span>*</span></label>
<input type="text" name="FirstName" id="firstName" required="" tabindex="0" aria-required="true">
<input type="hidden" id="firstNameAlert" data-message="Please enter your first name" disabled="disabled" tabindex="0">
</div>
<div class="large-6 medium-6 small-12 columns">
<label for="lastName">Last Name<span>*</span></label>
<input type="text" name="LastName" id="lastName" required="" tabindex="0" aria-required="true">
<input type="hidden" id="lastNameAlert" data-message="Please enter your last name" disabled="disabled" tabindex="0">
</div>
</div>
<div class="row">
<div class="large-6 medium-6 small-12 columns">
<label for="emailAddress">Email Address<span>*</span></label>
<input type="email" name="Email" id="emailAddress" required="" tabindex="0" aria-required="true">
<input type="hidden" id="emailRequired" data-message="Please enter an email address" disabled="disabled" tabindex="0">
<input type="hidden" id="emailCheckAlert" data-message="You must enter a valid email address" disabled="disabled" tabindex="0">
</div>
<div class="large-6 medium-6 small-12 columns">
<label for="telephone">Telephone</label>
<input type="tel" name="Phone" id="telephone" tabindex="0">
<input type="hidden" id="phoneRequired" data-message="" disabled="disabled" tabindex="0">
</div>
</div>
<div class="row">
<div class="large-12 columns">
<label for="relationship">Relationship to Victor<span>*</span></label>
<div class="radio" required="" aria-required="true">
<input type="radio" name="Relationship" value="client" tabindex="0">
<label for="client">Client/Insured</label>
<input type="radio" name="Relationship" value="vendor" tabindex="0">
<label for="vendor">Broker/Advisor</label>
<input type="radio" name="Relationship" value="other" required="" tabindex="0" aria-required="true">
<label for="other">Other</label>
<input type="hidden" id="relationshipRequired" data-message="Please select an option that best describes your relationship to Victor" disabled="disabled" tabindex="0">
</div>
</div>
</div>
<div class="row">
<div class="large-12 medium-12 small-12 columns">
<label for="companyName">Company<span>*</span></label>
<input type="text" name="CompanyName" id="companyName" required="" tabindex="0" aria-required="true">
<input type="hidden" id="companynameRequired" data-message="Please enter your company name, or N/A if this does not apply" disabled="disabled" tabindex="0">
</div>
</div>
<div class="row">
<div class="large-6 medium-6 small-12 columns">
<label for="postalCode">Postal Code</label>
<input type="text" name="PostalCode" id="postalCode" tabindex="0">
</div>
<div class="large-6 medium-6 small-12 columns">
<label for="regionSelect">Country</label>
<select class="country-selection" name="Country">
<option value="select" selected="selected"> Select a country </option>
<option value="Afghanistan"> Afghanistan </option>
<option value="Albania"> Albania </option>
<option value="Algeria"> Algeria </option>
<option value="American Samoa"> American Samoa </option>
<option value="Andorra"> Andorra </option>
<option value="Angola"> Angola </option>
<option value="Anguilla"> Anguilla </option>
<option value="Antarctica"> Antarctica </option>
<option value="Antigua and Barbuda"> Antigua and Barbuda </option>
<option value="Argentina"> Argentina </option>
<option value="Armenia"> Armenia </option>
<option value="Aruba"> Aruba </option>
<option value="Australia"> Australia </option>
<option value="Austria"> Austria </option>
<option value="Azerbaijan"> Azerbaijan </option>
<option value="Bahamas"> Bahamas </option>
<option value="Bahrain"> Bahrain </option>
<option value="Bangladesh"> Bangladesh </option>
<option value="Barbados"> Barbados </option>
<option value="Belarus"> Belarus </option>
<option value="Belgium"> Belgium </option>
<option value="Belize"> Belize </option>
<option value="Benin"> Benin </option>
<option value="Bermuda"> Bermuda </option>
<option value="Bhutan"> Bhutan </option>
<option value="Bolivia"> Bolivia </option>
<option value="Bosnia and Herzegovina"> Bosnia and Herzegovina </option>
<option value="Botswana"> Botswana </option>
<option value="Bouvet Island"> Bouvet Island </option>
<option value="Brazil"> Brazil </option>
<option value="British Indian Ocean Territory"> British Indian Ocean Territory </option>
<option value="British Virgin Islands"> British Virgin Islands </option>
<option value="Brunei Darussalam"> Brunei Darussalam </option>
<option value="Bulgaria"> Bulgaria </option>
<option value="Burkina Faso"> Burkina Faso </option>
<option value="Burundi"> Burundi </option>
<option value="Cambodia"> Cambodia </option>
<option value="Cameroon"> Cameroon </option>
<option value="Canada"> Canada </option>
<option value="Cape Verde"> Cape Verde </option>
<option value="Cayman Islands"> Cayman Islands </option>
<option value="Central African Republic"> Central African Republic </option>
<option value="Chad"> Chad </option>
<option value="Chile"> Chile </option>
<option value="China"> China </option>
<option value="Christmas Island"> Christmas Island </option>
<option value="Cocos"> Cocos </option>
<option value="Colombia"> Colombia </option>
<option value="Comoros"> Comoros </option>
<option value="Congo"> Congo </option>
<option value="Cook Islands"> Cook Islands </option>
<option value="Costa Rica"> Costa Rica </option>
<option value="Croatia"> Croatia </option>
<option value="Cuba"> Cuba </option>
<option value="Cyprus"> Cyprus </option>
<option value="Czech Republic"> Czech Republic </option>
<option value="Denmark"> Denmark </option>
<option value="Djibouti"> Djibouti </option>
<option value="Dominica"> Dominica </option>
<option value="Dominican Republic"> Dominican Republic </option>
<option value="East Timor"> East Timor </option>
<option value="Ecuador"> Ecuador </option>
<option value="Egypt"> Egypt </option>
<option value="El Salvador"> El Salvador </option>
<option value="Equatorial Guinea"> Equatorial Guinea </option>
<option value="Eritrea"> Eritrea </option>
<option value="Estonia"> Estonia </option>
<option value="Ethiopia"> Ethiopia </option>
<option value="Falkland Islands"> Falkland Islands </option>
<option value="Faroe Islands"> Faroe Islands </option>
<option value="Fiji"> Fiji </option>
<option value="Finland"> Finland </option>
<option value="France"> France </option>
<option value="French Guiana"> French Guiana </option>
<option value="French Polynesia"> French Polynesia </option>
<option value="French Southern Territories"> French Southern Territories </option>
<option value="Gabon"> Gabon </option>
<option value="Gambia"> Gambia </option>
<option value="Georgia"> Georgia </option>
<option value="Germany"> Germany </option>
<option value="Ghana"> Ghana </option>
<option value="Gibraltar"> Gibraltar </option>
<option value="Greece"> Greece </option>
<option value="Greenland"> Greenland </option>
<option value="Grenada"> Grenada </option>
<option value="Guadeloupe"> Guadeloupe </option>
<option value="Guam"> Guam </option>
<option value="Guatemala"> Guatemala </option>
<option value="Guinea"> Guinea </option>
<option value="Guinea-Bissau"> Guinea-Bissau </option>
<option value="Guyana "> Guyana </option>
<option value="Haiti"> Haiti </option>
<option value="Heard and McDonald Islands"> Heard and McDonald Islands </option>
<option value="Honduras"> Honduras </option>
<option value="Hong Kong SAR"> Hong Kong SAR </option>
<option value="Hungary"> Hungary </option>
<option value="Iceland"> Iceland </option>
<option value="India"> India </option>
<option value="Indonesia "> Indonesia </option>
<option value="Iran"> Iran </option>
<option value="Iraq"> Iraq </option>
<option value="Ireland"> Ireland </option>
<option value="Israel"> Israel </option>
<option value="Italy"> Italy </option>
<option value="Ivory Coast"> Ivory Coast </option>
<option value="Jamaica"> Jamaica </option>
<option value="Japan"> Japan </option>
<option value="Jordan"> Jordan </option>
<option value="Kazakhstan"> Kazakhstan </option>
<option value="Kenya"> Kenya </option>
<option value="Kiribati"> Kiribati </option>
<option value="Korea"> Korea </option>
<option value="Kuwait"> Kuwait </option>
<option value="Kyrgyzstan"> Kyrgyzstan </option>
<option value="Laos"> Laos </option>
<option value="Latvia"> Latvia </option>
<option value="Lebanon"> Lebanon </option>
<option value="Lesotho"> Lesotho </option>
<option value="Liberia"> Liberia </option>
<option value="Libya"> Libya </option>
<option value="Liechtenstein"> Liechtenstein </option>
<option value="Lithuania"> Lithuania </option>
<option value="Luxembourg"> Luxembourg </option>
<option value="Macau SAR"> Macau SAR </option>
<option value="Macedonia"> Macedonia </option>
<option value="Madagascar"> Madagascar </option>
<option value="Malawi"> Malawi </option>
<option value="Malaysia"> Malaysia </option>
<option value="Maldives"> Maldives </option>
<option value="Mali"> Mali </option>
<option value="Malta"> Malta </option>
<option value="Marshall Islands"> Marshall Islands </option>
<option value="Martinique"> Martinique </option>
<option value="Mauritania"> Mauritania </option>
<option value="Mauritius"> Mauritius </option>
<option value="Mayotte"> Mayotte </option>
<option value="Mexico"> Mexico </option>
<option value="Micronesia"> Micronesia </option>
<option value="Moldova"> Moldova </option>
<option value="Monaco"> Monaco </option>
<option value="Mongolia"> Mongolia </option>
<option value="Montserrat"> Montserrat </option>
<option value="Morocco"> Morocco </option>
<option value="Mozambique"> Mozambique </option>
<option value="Myanmar"> Myanmar </option>
<option value="Namibia"> Namibia </option>
<option value="Nauru"> Nauru </option>
<option value="Nepal"> Nepal </option>
<option value="Netherlands"> Netherlands </option>
<option value="Netherlands Antilles"> Netherlands Antilles </option>
<option value="New Caledonia"> New Caledonia </option>
<option value="New Zealand"> New Zealand </option>
<option value="Nicaragua"> Nicaragua </option>
<option value="Niger"> Niger </option>
<option value="Nigeria"> Nigeria </option>
<option value="Niue"> Niue </option>
<option value="Norfolk Island"> Norfolk Island </option>
<option value="North Korea"> North Korea </option>
<option value="Northern Mariana Islands"> Northern Mariana Islands </option>
<option value="Norway"> Norway </option>
<option value="Oman"> Oman </option>
<option value="Pakistan"> Pakistan </option>
<option value="Palau"> Palau </option>
<option value="Panama"> Panama </option>
<option value="Papua New Guinea"> Papua New Guinea </option>
<option value="Paraguay"> Paraguay </option>
<option value="Peru"> Peru </option>
<option value="Philippines"> Philippines </option>
<option value="Pitcairn"> Pitcairn </option>
<option value="Poland"> Poland </option>
<option value="Portugal"> Portugal </option>
<option value="Puerto Rico"> Puerto Rico </option>
<option value="Qatar"> Qatar </option>
<option value="Reunion"> Reunion </option>
<option value="Romania"> Romania </option>
<option value="Russia"> Russia </option>
<option value="Rwanda"> Rwanda </option>
<option value="S. Georgia and S. Sandwich Islands"> S. Georgia and S. Sandwich Islands </option>
<option value="Saint Kitts and Nevis"> Saint Kitts and Nevis </option>
<option value="Saint Lucia"> Saint Lucia </option>
<option value="Saint Vincent and The Grenadines"> Saint Vincent and The Grenadines </option>
<option value="Samoa"> Samoa </option>
<option value="San Marino"> San Marino </option>
<option value="Sao Tome and Principe"> Sao Tome and Principe </option>
<option value="Saudi Arabia"> Saudi Arabia </option>
<option value="Senegal"> Senegal </option>
<option value="Serbia"> Serbia </option>
<option value="Seychelles"> Seychelles </option>
<option value="Sierra Leone"> Sierra Leone </option>
<option value="Singapore"> Singapore </option>
<option value="Slovakia"> Slovakia </option>
<option value="Slovenia"> Slovenia </option>
<option value="Somalia"> Somalia </option>
<option value="South Africa"> South Africa </option>
<option value="South Sudan"> South Sudan </option>
<option value="Spain"> Spain </option>
<option value="Sri Lanka"> Sri Lanka </option>
<option value="St. Helena"> St. Helena </option>
<option value="St. Pierre and Miquelon"> St. Pierre and Miquelon </option>
<option value="Sudan"> Sudan </option>
<option value="Suriname"> Suriname </option>
<option value="Svalbard and Jan Mayen Islands"> Svalbard and Jan Mayen Islands </option>
<option value="Swaziland"> Swaziland </option>
<option value="Sweden"> Sweden </option>
<option value="Switzerland"> Switzerland </option>
<option value="Syria"> Syria </option>
<option value="Taiwan"> Taiwan </option>
<option value="Tajikistan"> Tajikistan </option>
<option value="Tanzania"> Tanzania </option>
<option value="Thailand"> Thailand </option>
<option value="Togo"> Togo </option>
<option value="Tokelau"> Tokelau </option>
<option value="Tonga"> Tonga </option>
<option value="Trinidad and Tobago"> Trinidad and Tobago </option>
<option value="Tunisia"> Tunisia </option>
<option value="Turkey"> Turkey </option>
<option value="Turkmenistan"> Turkmenistan </option>
<option value="Turks and Caicos Islands"> Turks and Caicos Islands </option>
<option value="Tuvalu"> Tuvalu </option>
<option value="Uganda"> Uganda </option>
<option value="Ukraine"> Ukraine </option>
<option value="United Arab Emirates"> United Arab Emirates </option>
<option value="United Kingdom"> United Kingdom </option>
<option value="Uruguay"> Uruguay </option>
<option value="USA"> USA </option>
<option value="US Minor Outlying Islands"> US Minor Outlying Islands </option>
<option value="US Virgin Islands"> US Virgin Islands </option>
<option value="Uzbekistan"> Uzbekistan </option>
<option value="Vanuatu"> Vanuatu </option>
<option value="Venezuela"> Venezuela </option>
<option value="Vietnam"> Vietnam </option>
<option value="Wallis and Futuna Islands"> Wallis and Futuna Islands </option>
<option value="Western Sahara"> Western Sahara </option>
<option value="Yemen"> Yemen </option>
<option value="Zambia"> Zambia </option>
<option value="Zimbabwe"> Zimbabwe </option>
</select>
<span></span>
</div>
</div>
<div class="row">
<div class="large-12 medium-12 small-12 columns text-field">
<label for="help">Question or Comment<span>*</span></label>
<textarea type="text" name="Request" id="helpDescription" required="" tabindex="0" aria-required="true"></textarea>
<input type="hidden" id="helpAlert" data-message="Please enter a question or comment" disabled="disabled" tabindex="0">
</div>
</div>
<div class="row security">
<div class="large-6 medium-6 small-12 columns">
<div id="g-recaptcha">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA"
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<input type="hidden" id="captchaCheck" value="" name="captcha" tabindex="0">
<input type="hidden" disabled="disabled" id="captchaAlert" data-message="Please complete this section" name="captcha" tabindex="0">
</div>
</div>
<div class="row policy-check">
<div class="large-12 medium-12 small-12 columns">
<input id="policies" name="policies_check" type="checkbox" tabindex="0"> Please check this box to acknowledge agreement to allow Victor to respond to your request or comment using the information you have provided in this form. <span>*</span>
<input type="hidden" id="policiesRequired" data-message="Please check this box to agree" disabled="disabled" tabindex="0">
</div>
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<div class="row">
<div class="large-6 medium-12 small-12 columns">
<input class="submit-button" id="contactButton" name="contactButton" type="submit" value="Submit" tabindex="0">
</div>
</div>
<input type="hidden" id="requiredAlert" data-message="" disabled="disabled" tabindex="0">
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Get a Quote/Application Home About Us Who We Are Leadership Team Careers Newsroom Contact Us Resources Property & Liability Insurance About Us Who We Are Leadership Team Careers Newsroom Contact Us Solutions Types of Coverage Architects & Engineers Professional Liability Builders Risk Insurance CGL Commercial Property Insurance Commercial Umbrella Liability Crime Insurance Cyber Insurance Directors & Officers Liability Employment Practices Liability Environmental & Pollution Liability Errors & Omissions Fiduciary Liability Technology Insurance Wrap-Up Liability Industries We Serve Agriculture Airports (Private) Architects and Engineers Associations and Affinity Groups Childcare/Daycare Construction Crown Corporations Energy, Oil and Gas Educational Institutions Environmental Consultants Financial Institutions & Professionals Forestry Government Agencies Health Care Hospitality Hospitals and Medical Facilities Insurance Professionals Land Surveyors Landscape Architects Law Firms and Legal Professionals Manufacturers and Suppliers Media and Communications Marinas Mining Municipalities Non-Profit Organizations Professional Services and Consultants Property Owners Real Estate Restaurants Retailers and Wholesalers Sports, Leisure and Recreation Start-up Companies Technology Transportation Utilities Waste Storage Facilities Claims Claims - Property & Liability Insurance Report a Claim - Property & Liability Insurance Learning Centre eLearning Risk Analysis Charts Webinars, Webcasts Resources Group Benefits About Us Who We Are Leadership Team Careers Newsroom Contact Us Solutions Types of Coverage GB Program Overview Online Services Online Services Get a Quote Plan Advisor Marketing Kit Claims Submit a Claim - Group Benefits Resources Retiree Benefits About Us Who We Are Leadership Team Careers Newsroom Contact Us Solutions Types of Coverage Annual Travel Insurance RecoverEase Insurance Health & Dental Care Benefits Individual Insurance – Travel Plans Life Insurance Program Overview Online Services Online Quotes & Enrollment Online Policyholder Services Claims Submit a Claim - Retiree Benefits Resources Careers at Victor Why Work at Victor Job Opportunities Canada Victor - Canada Victor US Victor UK Victor Deutschland Victor Italia Victor Nederland Key Underwriting Dovetail - US ICAT - US English Français * * * * * Home About Us Who We Are Contact Us Leadership Team Careers Newsroom Resources Get a Quote/Application GET A QUOTE/APPLICATION. PROPERTY & LIABILITY INSURANCE Get a quote or discuss coverage options with a Victor underwriter. * Get a Quote * Get an Application GROUP BENEFITS Learn more about how to obtain a quote or discuss coverage options. * Get a Quote RETIREE BENEFITS V+ is your portal to pricing and enrollment for your post-retirement personal insurance. Get a quote and purchase coverage for life, health and travel insurance in mere minutes. Learn more. * Get a Quote & Enroll Sign in SIGN IN PROPERTY & LIABILITY INSURANCE Work smarter with V2 (V Squared). Sign in to V2 to access personalized online quote-to-bind services for several of our products. It will maximize your productivity, while providing comprehensive coverage options for your clients. * Log in to V Squared GROUP BENEFITS If you are a group benefits plan advisor, plan administrator or plan member, this secure site is for you. 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