<html> <body> <form-template> <fields> <field type="header" subtype="h1" label="Travel Insurance Price Quote"/> <field type="paragraph" subtype="p" label="Fill out this form for a no obligation travel insurance quote. Please answer each question as best you can. Every province has their own regulations when it comes to insurance so we have to know where you live to be able to quote correctly.&nbsp;"/> <field type="header" subtype="h2" label="Full name"/> <field type="text" required="true" label="First name" name="first-name" subtype="text" className="form-control"/> <field type="text" required="true" label="Last name" name="last-name" subtype="text" className="form-control"/> <field type="date" required="true" label="Birthday" name="birthday" className="form-control"/> <field type="text" required="true" label="Phone number" name="phone-number" subtype="text" className="form-control"/> <field type="text" required="true" label="Email" name="email" subtype="text" className="form-control"/> <field type="header" subtype="h2" label="Address"/> <field type="text" label="Line 1" name="address-line-1" subtype="text" className="form-control"/> <field type="text" label="Line 2" name="address-line-2" subtype="text" className="form-control"/> <field type="text" label="City" name="address-city" subtype="text" className="form-control"/> <field type="text" required="true" label="Province" name="address-state" subtype="text" className="form-control"/> <field type="text" label="Postal Code" name="address-zip" subtype="text" className="form-control"/> <field type="text" label="Country" name="address-country" subtype="text" className="form-control"/> <field type="textarea" label="Names of additional travellers and dates of birth" name="names-of-additional-travellers-and-dates-of-birth" className="form-control"/> <field type="select" label="Do all travellers live at the same address?" name="do-all-travellers-live-at-the-same-address" className="form-control"> <option label="Yes " value="yes-">Yes </option> <option label="No" value="no">No</option> <option label="n/a" value="na">n/a</option> </field> <field type="checkbox-group" required="true" label="What type of coverage are you looking for? (check all that apply)" description="see travel insurance solutions flyers for details on each coverage" name="what-type-of-coverage-are-you-looking-for-check-all-that-apply"> <option label="Comprehensive Single-trip Plan" value="comprehensive-singletrip-plan">Comprehensive Single-trip Plan</option> <option label="Emergency Hospital & Medical" value="emergency-hospital-medical">Emergency Hospital & Medical</option> <option label="Non-medical Package " value="nonmedical-package-">Non-medical Package </option> <option label="Trip Cancellation & Interruption" value="trip-cancellation-interruption">Trip Cancellation & Interruption</option> <option label="Visitors to Canada Travel Medical" value="visitors-to-canada-travel-medical">Visitors to Canada Travel Medical</option> <option label="Comprehensive Multi-Trip Plan" value="comprehensive-multitrip-plan">Comprehensive Multi-Trip Plan</option> <option label="Emergency Hospital & Medical Multi-Trip Plan" value="emergency-hospital-medical-multitrip-plan">Emergency Hospital & Medical Multi-Trip Plan</option> </field> <field type="checkbox-group" required="true" label="Are all insureds covered for medical under a valid government health insurance plan?" name="are-all-insureds-covered-for-medical-under-a-valid-government-health-insurance-plan"> <option label="Yes" value="yes">Yes</option> <option label="No" value="no">No</option> <option label="Not sure" value="not-sure">Not sure</option> </field> <field type="date" required="true" label="Start date of travel" name="start-date-of-travel" className="form-control"/> <field type="date" required="true" label="Return date of travel (must be date that you return to Canada)" name="return-date-of-travel-must-be-date-that-you-return-to-canada" className="form-control"/> <field type="text" required="true" label="Where are you travelling to?" name="where-are-you-travelling-to" subtype="text" className="form-control"/> <field type="text" required="true" label="What is the total value of the trip you are insuring?" name="what-is-the-per-person-value-of-the-trip-you-are-insuring" subtype="text" className="form-control"/> <field type="select" required="true" label="Which West Canadian Travel consultant do you work with?" name="which-west-canadian-travel-consultant-do-you-work-with" className="form-control"> <option label="No one yet" value="no-one-yet">No one yet</option> <option label="Lisa Kraiger" value="lisa-kraiger">Lisa Kraiger</option> <option label="Carrie Desjarlais" value="carrie-desjarlais">Carrie Desjarlais</option> <option label="Janice Gillis" value="janice-gillis">Janice Gillis</option> <option label="Andrea Timmermans" value="andrea-timmermans">Andrea Timmermans</option> <option label="Maria Burton" value="maria-burton">Maria Burton</option> <option label="Eldon & Jackie Gibb" value="eldon-jackie-gibb">Eldon & Jackie Gibb</option> <option label="Derek Burns" value="derek-burns">Derek Burns</option> <option label="Kristi Stawnychy" value="kristi-stawnychy">Kristi Stawnychy</option> <option label="Leah Davis" value="leah-davis">Leah Davis</option> <option label="Angela Duguid" value="angela-duguid">Angela Duguid</option> <option label="*other" value="other">*other</option> </field> <field type="text" label="*if "other" was selected please enter name of Travel Consultant" name="if-other-was-selected-please-enter-name-of-travel-consultant" subtype="text" className="form-control"/> </fields> </form-template> </body> </html>
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American Airlines (AAdvantage)
United Airlines (Mileage Plus)
Delta Air Lines (SkyMiles)
Hilton (Honors)
Marriott Bonvoy
Southwest Airlines (Rapid Rewards)
IHG Rewards Club
Hyatt (World of Hyatt)
JetBlue Airways (trueBlue)
British Airways (Executive Club)
Alaska Airlines (Mileage Plan)
Hertz Gold Plus Rewards
Virgin America (eleVAte)
Club Carlson Hotels
Avis (Preferred)
Amtrak (Guest Rewards)
National (Emerald Club)
Wyndham Rewards (Days Inn, etc.)
Hawaiian Airlines (HawaiianMiles)
Choice Hotels (Choice Privileges)
Frontier Airlines (EarlyReturns)
Best Western Rewards
Lufthansa (Miles and More)
Virgin Atlantic (Flying Club)
Air Canada Aeroplan
Enterprise Rent-A-Car
Korean Air (SkyPass)
Air France (Flying Blue)
Singapore Airlines (KrisFlyer)
Emirates (Skywards)
Spirit Airlines (Free Spirit)
Le Club Accorhotels (Accor Hotels, Novotel, etc.)
Hotels.com Rewards
All Nippon Airways (ANA Mileage Club)
Cathay Pacific (Asia Miles)
Fairmont President's Club
Qantas (Frequent Flyer)
Budget (Fastbreak)
La Quinta, etc. (Returns)
Iberia Plus
Kimpton (Karma Rewards)
Asiana Airlines (Asiana Club)
Omni Hotels (Select Guest)
AviancaTaca (LifeMiles)
Alamo
Etihad Airways (Etihad Guest)
Aegean Airlines (Miles & Bonus)
KLM (Flying Blue)
MGM Resorts (M life Players Club)
Japan Airlines (JMB)
AirBerlin (Topbonus)
LATAM (LATAM Pass)
Thrifty (Blue Chip Rewards)
Royal Caribbean (Crown & Anchor Society)
Alitalia (MilleMiglia)
Qatar Airways (Qmiles)
Jet Airways (JetPrivilege)
Turkish Airlines (Miles&Smiles)
Icelandair (Saga Club)
Dollar Rent A Car (Express)
Carnival (VIFP)
Eva Air (Infinity MileageLands)
Sun Country Airlines (Ufly Rewards)
Shangri-La (Golden Circle)
Air India (Flying Returns)
Sixt Rent-a-Car
BMI (Diamond Club)
Booking.com
Loews Hotels (YouFirst Rewards)
Norwegian Air Shuttle ASA (Norwegian Reward)
Stash Hotel Rewards
Scandinavian Airlines System (EuroBonus)
Norwegian Cruise Line (Latitudes)
Aeromexico (Club Premier)
Copa Airlines ConnectMiles (Prefer)
Celebrity Cruises (Captain's Club)
Drury Hotels (Gold Key Club)
Aer Lingus (Gold Circle)
Virgin Australia (Velocity Frequent Flyer)
EL AL Israel Airlines (Matmid)
Princess Cruise Lines (Captain Circle)
China Airlines (Dynasty Flyer)
Delta (SkyBonus Corporate)
Melia (Melia Rewards)
GHA (Discovery)
Air China (PhoenixMiles)
Air Asia (BIG)
Gol Airlines (Smiles)
Malaysia Airlines (Enrich)
Air New Zealand (Airpoints)
WestJet (Frequent Guest)
Porter (VIPorter)
Agoda Rewards
Thai Airways (Royal Orchid Plus)
VOILÀ Hotel Rewards
Preferred Hotels, etc. (iPrefer)
Red Roof Inn (RediCard)
Aeroflot Bonus
China Eastern (Eastern Miles)
Holland America Line (Mariner Society)
Philippine Airlines (Mabuhay Miles)
Bangkok Airways (FlyerBonus)
Hilton Grand Vacations (Club)
South African Airways (Voyager)
China Southern (Sky Pearl)
Finnair Plus
Small Luxury Hotels (The Club)
TAP Portugal (Victoria Miles)
Avianca (Amigo)
Langham Hotels (1865 Club)
Fox Rent A Car (Rewards)
Hainan Airlines (Fortune Wings)
AmericInn (Easy Rewards)
Disney Cruise Line (Castaway Club)
Payless Car Rental (Perks Club)
Azul (TudoAzul)
Starwood Hotels (Preferred Business)
My Europcar (Privilege)
Hyatt (Vacation Club)
Aerolineas Argentinas (Plus)
Taj (InnerCircle)
British Airways (On Business, Corporate)
Leading Hotels of the World (Leaders Club)
Eurostar Frequent Traveler
Red Lion (Hello Rewards)
Air Tahiti Nui (Club Tiare)
United PerksPlus (Corporate Program)
NH Hotels (NH World)
Swissotel Circle
Millennium & Copthorne (My Millennium)
Ethiopian Airlines (ShebaMiles)
Royal Air Maroc (Safar Flyer)
Alaska Airlines (EasyBiz Corporate)
Vueling Airlines (Punto Punto)
Gulf Air (Falconflyer)
Star Alliance Company (PlusAwards)
Coast Hotels (Coast Rewards)
Royal Jordanian Airlines (Royal Plus)
HotelClub (Member Rewards)
Czech Airlines (OK Plus)
VIA Rail Canada (VIA Preference)
Trump Card (Privileges Program)
Borgata (Rewards)
Saudi Arabian Airlines (Alfursan)
Vietnam Airlines (Golden Lotus Plus)
Egypt Air Plus
Scandic Hotels (Scandic Friends)
JetBlue Airways (CompanyBlue)
Hostelworld (My World)
Jumeirah (Sirius)
E-Z Rent-A-Car (E-Z Money)
Deutsche Bahn (BahnCard)
Garuda (Frequent Flyer)
TripAdvisor
Kuwait Airways (Oasis Club)
Cosmopolitan Hotels (Identity)
Advantage Rent a Car (Instant Rewards)
Cayman Airways (Sir Turtle Rewards)
Caribbean Airlines (Caribbean Miles)
RIU Hotels & Resorts (RIU Class)
Easyjet
SriLankan (FlySmiLes)
TabletHotels (Reward Dollars)
Ace Rent a Car
Thalys (The Card)
S7 Priority
Air Baltic (Pins)
Choice Hotels (Nordic Choice Club)
Trident Hotels (Trident Privilege)
Middle East Airlines (Cedar Miles)
Emirates for Kids (Skysurfer)
Rydges (PriorityGUEST)
Oman Air (Sindbad)
Island Air (Cloud 9)
Ukraine International Airlines (Panorama Club)
Flybe (Rewards4all)
SNCF (Voyageur)
Marriott Gift Cards
Qantas (Aquire)
Pegasus Airlines (Pegasus Plus)
Air Transat
Silver Cloud (Rewards)
Brussels Airlines (LOOPs)
JAL Hotels (One Harmony)
Eurowings (Boomerang)
Azamara (Le Club Voyage)
Otel.com (FivePlus)
Meridiana Fly (Hi-Fly)
Prince Resorts Hawaii (Prince Preferred)
PIA (Awards Plus)
Air Astana (Nomad Club)
Regal Hotels (Regal Rewards)
IndiGo
Era Alaska (FlyAway Rewards)
Red Spotted Hanky (Loyalty points)
Thon Hotels (Thon Member)
Air Jamaica (Seventh Heaven)
Trenitalia (FrecciaClub)
Air Malta (Flypass)
Splendia (Club Rewards)
Dorint (Card)
UTair (Status)
Tsogo Sun (Frequent Guest)
Sino Hotel Group (IPrestige)
KLM BlueBiz (Corporate)
RZD (Bonus)
Elite Hotels of Sweden
New Otani (Club International)
Air Algérie (Air Algérie Plus)
Ryanair
The Montcalm & Shaftsbury (Premier Club)
Dan Hotels (e-dan club)
Pestana Priority Guest
Macdonald Hotels (The Club)
Air Mauritius (Kestrelflyer)
Frasers Hospitality (Fraser World)
AirBerlin (business points)
Park-N-Go (Frequent Parker Rewards)
Localiza Rent a Car
Jurys Inn (Jurys Rewards)
Air Caraibes (Preference)
Bulgaria Air (Fly More)
Air Niugini (Destinations)
TUIfly.com
Cebu Pacific (Getgo)
Premier Hotels (Premier Club)
Jet2.com (My Jet2)
Air Austral (My Capricorne)
CAT (C-Club)
Opinion Miles Club
Ural Airlines (Wings)
Air Europa (SUMA)
Monarch (Vantage Club)
Stena Line (Extra)
La Compagnie (My Compagnie)
First Hotels (First Member)
Belavia (Leader)
Azerbaijan Airlines (Azal Miles)
Wizz Air (Discount Club)
Tunisair (Fidelys)
Paradores (Amigos de Paradores)
Vistara (Vistara Club)
Montenegro Airlines (Vision Team)
Asky Airlines (ASKY Club)
Jinling Hotels (Elite)
Moby Lines (Moby Club)
Jin Jiang Group (J-Club)
AtlasGlobal (AtlasMiles)
Qubus Hotel (Q-Club)
Braathens Regional Airlines (BRA Friends )
Hotelbooker.org
Flynas (NaSmiles)
Czech Airlines (OK Plus Corporate)
Uzbekistan Airways (UzAirPlus)
TAAG Angola Airlines (Umbi Umbi Club)
Yelloh! Village (Yelloh! Plus)
Future Inns (Rewards Club)
Nordavia (Golden Mile)
Air Arabia (Airewards)
Royal Brunei Airlines (Royal Skies)
Leonardo Hotels (AdvantageCLUB)
Air Moldova Club
Air Cote D'Ivoire (sMiles)
Air Macau (Privileges)
Etihad (BusinessConnect)
Gloria Hotels & Resorts (Gloria Partner)
Santos Hotels (Club Santos)
Known Traveler Number (KTN)
Global Entry ID
TSA PreCheck
NEXUS ID
SENTRI ID
American Automative Association (AAA)
Sandals Select Guest (SSG)
Mandarin Oriental Fan
Relais and Chateaux 5C
Four Seasons Preferred
Dorchester Diamond
Peninsula Pen
Belmond Bellini
Silversea Venetian
Oceania Cruise Lines
Regent Cruise Line
Seabourn Cruise Line
Lindblad Expeditions
SeaDream Yacht Club
Cunard
Virgin Voyages Sailing Club
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