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REQUEST A QUOTE
Home Insurance Quote Request
Please complete the quote form below, and one of our qualified sales representatives will respond to you promptly!
* Name
:
* Phone
:
(
)
-
Email
:
* Street Address
:
* City
:
* Province
:
Ontario
* Postal Code
:
Present Coverage
Building Limit
:
Contents Limit
:
Liability Limit
:
Deductible
:
Do You Rent or Own
?
-- Select One --
Rent
Own
Location of Home
:
-- Select One --
Within 1,000' of fire hydrant
Within 13 kms. of firehall
Beyond 13 km of firehall
Shuttle Tank Service
Current Policy Form
:
Comprehensive
:
(yes/no)
Broad Form
:
(yes/no)
Primary Heat
:
Auxiliary Heat
:
Age of Home
:
Do You Have a Woodstove
:
-- Select One --
Yes
No
If Yes, is it CSA Approved
?
-- Select One --
Yes
No
If Yes, How Many Cord of Wood do you Burn per Year
?
Do Any Smokers Live in Your House
?
-- Select One --
Yes
No
Do you Have a Mortgage
?
-- Select One --
Yes
No
Do You Have an Alarm System
?
-- Select One --
Fire Alarm
Burglar Alarm
Central/Monitored
Claims in Last 5 Years (if yes provide brief details)
?
