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Insurance Estimate Request

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Please choose an Insurance Type*
- Auto/Motorcycle
- Home
Auto/Motorcycle
Home Insurance
Name*
First Last
Address
Phone*
Email*
Preferred Date to be Contacted
MM slash DD slash YYYY
Preferred Time
- 9am - 12pm
- 12pm - 4pm
Policy Type*
- Auto
- Motorcycle
Policy Type*
- Home Owner
- Tenant
Show/Hide Information*
- Submit without providing extra information.
- Provide driver and vehicle information.
- Provide additional information for home/auto package insurance.
Show/Hide Information*
- Submit without providing extra information.
- Provide home information.
- Provide additional information for home/auto package insurance.
- Drivers
- Driver Information
  Name Actions
  There are no Drivers.
  Maximum number of drivers reached.
- Vehicles
- Vehicle Information
  Vehicle Description Actions
  There are no Vehicles.
  Maximum number of vehicles reached.
Home Information
- Date of Birth*
  MM slash DD slash YYYY
- Occupation and Employer*
- Property Value (purchase price or amount of current coverage)*
- Years of Continuous Coverage*
- Number of mortgages on the home*
- Number of claims related to Home/Tenant insurance in the past 5 years*
- Type of Home*
- Style of Home*
- Square Footage of Home*
- Age of Home (years)*
- Number of stories, excluding the basement.*
- Is there a basement?*
  - Yes
  - No
- If there is a basement, what percentage is finished?*
- # of bathrooms*
- Is there a swimming pool?*
- Is there a garage?*
- Garage size?*
- Primary Type of Heat Source*
  - Heat Pump
  - Oil Furnace
  - Electric
  - Wood Stove
  - Geo-Thermal
  - Other
- Secondary Type of Heat Source*
  - None
  - Heat Pump
  - Oil Furnace
  - Electric
  - Wood Stove
  - Geo-Thermal
  - Other
- Plumbing Type*
  - Copper
  - Plastic
  - Cast Iron
  - Other
- Electrical Wiring*
  - Copper
  - Aluminum
  - Knob & Tube
  - Other
- Amp Service*
  - 100
  - 200
  - Other
- Breakers or Fuses*
  - Breakers
  - Fuses
- Are there any commercial or business activities on your premises or in your home?*
  - Yes
  - No
- Do you rent any part of your home? (includes AirB&B, Time Sharing, etc.)*
  - Yes
  - No
- Is there an alarm system?*
  - Yes
  - No
- Preventative measures for water/sewer back up.
  - Backflow valve
  - Sump Pump
Consent
We require your consent to collect the information below and share it as needed to underwrite and administer your insurance as per the Privacy Act. This includes insurance history and credit history (this is a soft credit check used for identity verification and additional discounts).*
I agree and consent.

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Driver Information

Name*
First Last
Date of Birth*
Month
Day
Year
How long licensed to drive in Canada?*
Drivers License Number*
Any accidents or claims (at fault or not), or convictions in the past 10 years?*
- Yes
- No
If 'Yes', please give details
Occupation & Employer*

Vehicle Information

Vehicle Description
OR... please provide Vehicle Serial Number
OR... please provide Vehicle Serial Number*
Average one way commute distance (kms)*
Annual mileage (kms)*