To get a no obligation quote on your commercial insurance, please complete the following form and submit it to our office. Your property quote will be e-mailed to you as soon as possible.

Please note: We can only provide insurance for residents of Ontario, Canada.

Please Note: It is imperative that all fields be completed for us to give you an accurate quote.

Contact Information

Home Phone:
Office Phone:	Ext.
Fax:
E-mail:

Insurance Information

Have you ever had your insurance cancelled or refused?
	YesNo
Do you currently have insurance?
	YesNo
When would you want the coverage to start? (dd/mm/yyyy)

Insurance Company:
Policy Number:

Business Information

Is your business a:	SelectRetail StoreOfficeContractorOther
What is your product/service:
What are your annual sales:	Select< $100,000$100,000-$250,000$250,000-$500,000$500,000-$1,000,000> $1,000,000
Number of employees:	SelectJust me2-56-1011-25> 25

Property Information

What year was it built:
Is it in a:	SelectHouseSingle BuildingStrip PlazaEnclosed MallHigh Rise Tower
Is it sprinklered:	YesNo
Are the walls:	SelectBrick/BlockConcreteWood FramePlaster/StuccoOther
Are the floors:	SelectWoodSteelConcrete
Is the roof:	SelectWoodSteelConcrete
If it is over 20 years old, have any of these been updated or replaced:	Furnace
	Roof
	Wiring
	Plumbing
Is there an alarm system:	SelectNoneBurglar OnlyFire OnlyBurglar & Fire
If yes, is it:	SelectLocal OnlyMonitored by company
Is your property Located within:	Select300m of Fire Hydrant 8 km of Fire HallNeither

Coverages & Deductibles

Please fill in the coverages you presently have.  The best place to find this information is on your current insurance policy.If a section does not apply to you, please leave it blank or fill in "n/a".  If you are uncertain of an answer, mention it in the comment section at the bottom.

Basic Coverages

Building Amount: ($)
Contents Amount: ($)
Liability Amount:	Select$500,000$1,000,000$2,000,000
Deductible:	Select$300$500$1,000
If you have any extra coverages, such as special coverages for computers, contractors equipment, tools, valuable paper, a/r, ect., please make a note of it in the comment section below.

Below are some popular optional coverages. Some of our small business packages include many of these. However, the included limits may be different than your existing policy. There are also many others not listed below. Please check the coverages in your policy carefully to ensure our quote will match your existing coverages.  Anything not listed below should be mentioned in the comments section.

Optional Coverages

Business Interruption: ($)
Outdoor Signs: ($)
Business Tools: ($)
Exterior Glass:	YesNo

Claims Information

		Date of Claim
	Type of Claim:	(mm/yyyy)	Location Involved:
1.	SelectNoneBreak-inFireJewelery Lost/StolenWater DamageOther		SelectNoneLocation1Location2
2.	SelectNoneBreak-inFireJewelery Lost/StolenWater DamageOther		SelectNoneLocation1Location2
3.	Select NoneBreak-in FireJewelery Lost/StolenWater DamageOther		SelectNoneLocation1Location2

Comments

Comment
Thank-you for taking the time to fill out this form. Select the "Submit" button below and we will e-mail you a quote by the next business day.   Our quote will include the coverages you selected plus the standard Accident Benefits coverages. We will include the cost of popular optional coverages with our quotation. Optional Accident Benefit coverages can be upgraded by consulting one of our brokers.