Business Insurance Quote Request
 
   
*Contact Name:
*Contact Phone:
*Email:
  Company Name:
  Fax Number:
  Address:
  City:
  Province:
  Postal Code:
   
Age of building:
Construction of building:
Is there sprinklers installed within the building property?
Yes     No
How much area do you occupy?
Are you the only tenant?
Yes     No
Is there a hydrant within 500 ft. (150 meters)?
Yes     No
Is there a fire hall within 3 miles (5 kms)?
Yes     No
Has insurance ever been denied or cancelled?
Yes     No
What type of business?
How many years in the business?
Number of Employees:
Have there been any insurance
claims in the last 3 years?
What are the annual receipts?
What is the annual payroll?
   
   
 
   
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