We would be happy to provide a quote on Homeowner's Insurance for you. Please fill out the following form and we will contact you with a quote as quickly as possible. This information will provide a basic quote.  For a more comprehensive quote, please contact our office and speak with one of our brokers.

Fields marked (*) are required

Applicant Information

Resident's Name:*

Street Address to Insure*:

City:*

Province:*

Postal Code:*

Home Phone Number:*

Work Phone Number:*

Email Address:*

Homeowners Insurance:

Previous Insurer:

Policy Number:

Policy Type: (Broad or Comprehensive)

Deductible ($):

Sewer Backup ($):

Discount Eligibility

Do you smoke:

When is your birthday:

Do you have a mortgage:

Do you have an alarm:

Local or monitored alarm:

Burglar, fire or both:

List dates of claims in the last 5 years:

General Information

Year Built:

Dwelling Type (Single Family/Duplux):

Number of floors in the building:

Total Square Feet:

Dwelling Style:
(Detached/Semi-Detached)

  

Ceiling

Cathedral (%):

8 ft (%):

9 ft (%):

Basement

Full Basement:

Finished (%):

Crawlspace (%):

Slab (%):

Exterior

Square Footage of other
Structures: (Garage/Porch)

Roofing Material:

Age of Roof:

Exterior Wall Material(s):

Interior Wall Coverings

Paint (%):

Ceramic Tile (%):

Wood Paneling (%):

Flooring

Hardwood (%):

Carpet (%):

Vinyl (%):

Wall to Wall Carpet (%):

Ceramic Tile (%):

Other (%):

Kitchen

Quantity:

Builder's Grade:

Semi-Custom:

Bathrooms

Quantity (Full):

Builder's Grade:

Semi-Custom:

Quantity (Half):

Builder's Grade:

Semi-Custom:

Plumbing

Copper (%):

PVC (%):

Galvanized (%):

Year Updated:

Utilities

Style of Heating:

Year Updated:

Electrical - How many amps?

Year Updated:

Breakers or Fuses?

Additional Interior Items

Fireplace:

Wood Stove:

Hot Tub:

Wet Bar:

Sauna:

Jacuzzi:

French Doors: