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What product are you interested in?
*
Auto
Home
What is the expiry date of your current policy?
*
MM slash DD slash YYYY
Province
*
Choose your province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
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Home
Home address
*
Street Address
Address Line 2
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code
How much is your home currently insured for?
or, if Tenant – contents limit
or, if Condo Owner – contents limit?
When was the home built?
*
Any insurance claims in the past 3 years?
*
Yes
No
Does the home have a monitored alarm system?
*
Yes
No
Is there a mortgage or line of credit on the property?
*
Yes
No
Is anyone living in the home over 45 years of age?
*
Yes
No
Are there any woodstoves in the home?
*
Yes
No
Is the home within 1000ft of a fire hydrant?
*
Yes
No
Is the home within 13km of a firehall?
*
Yes
No
Please send quote to:
First Name
*
Last Name
*
Group/employer
*
Email
*
Phone
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Fax
Preferred method of contact
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Phone
Email
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Group Insurance
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