Home Quote | Une Soumission SVP

First name

Last name

Date Of Birth

Email Address

Company Name

Address Line 1

City

Province

Postal Code

Apartment No

Would you like us to shop around for you each 2 years? Yes No

When the contract should start?

Which is the year it has been built?

Electricity amperage?

Electricity Wiring?

Electricity Panel?

Plumbing?

What is the latest electrical update?

What is the latest plumbing update?

What is the year of the roof?

What is the type of roof you have?

Are there any changes to doors? YES NO

Are there any changes to windows? YES NO

The basement is made of?

Is the basement finish? YES NO

What is your isolation type?

Which is the year of the hot water tank?

Do you have a mortgagee? YES NO

Do you have a woodstove or fire place? YES NO

Approved device YES NO

Appliance and chimney installation by a professionals ? YES NO

Appliance and chimney installation according to manufacturers standards ? YES NO

Frequency of sweeping

Month of the last sweeping ?

Year of the last sweeping ?

Quantity of wood used per year ?

Since how many years you have been living here?

Liability 1 Million 2 Millions

Do you have a criminal file? YES NO

Do you have any claim in the past 7 year's? YES NO

Would you like to cover art? YES NO

Do you have any bycicle that worth more than 3,000$? YES NO

Do you have jewelry that exceed more than 5,000 per article and a maximum of 10,000$? YES NO

Does the insurance company refuse to renew the risk? YES NO

Does your client ever have an interruption of insurance? YES NO

Quote

Personnal informations

Home Information

Protection

Services

Useful Links

Email

Phone

Address