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Get an Auto Insurance Quote

Name:
Address:
City:
Province:
Postal Code:
Phone number:
Email:
Years Continuously Insured:
Estimated replacement value of personal property:
Policy Deductible Preferred:
Liability Amount Requested:
Have you had any personal property claims in the last 3 years:	YesNo
Text box:

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Name:
Full Address:
Email:
Phone number:
Any claims in the past 5 years? :	Yes No
Year home was built? :
How many stories? :
Square Footage of home:
Is the basement finished:	Yes No
Do you have a monitored alarm system:	Yes No
Is anyone that resides in the home a smoker:	Yes No
Have any of the following been updated in the past 15 years:	Electrical Hot Water Tank Roof / Shingles Furnace Plumbing
What type of electrical wiring is in the house:	Copper Aluminum Wiring Knob and Tube
Do you have a Pool or Hot Tub:	Yes No
Do you have any wood burning stoves:	Yes No
Are you self-employed or run any business out of the home:	Yes No

Name:
Email Address:
Address:
City:
Province:
Postal Code:
Phone Number:
Age of Building:
Construction of building:
Is the building sprinklered:	Yes No
How much area do you occupy:
Are you the only tenant:	YesNo
Is there a hydrant within 500 ft. (150 metres):	YesNo
Is there a fire hall within 3 miles (5 kms):	YesNo
Has insurance ever been denied or canceled:	YesNo
What type of business:
How many years in the business:
Have there been any insurance claims in the last 3 years:
What are the annual receipts:
What is the annual payroll:
Text box: