Property Insurance Quote | Tregunno Group | Burlington Insurance Brokers

Client Information

Name(s): *

Phone Number: *

Email(s): *

Current Address: *

City, Province: *

Postal Code: *

APPLICANT

Applicant Name (s): *

Applicant Date(s) of Birth: *

Last Move Date: *

Previous Address: *

City, Province: *

Postal Code: *

Coverage Details:

*

HOMEOWNER

TENANT

RENTAL

CONDO

Year house was built: *

Occupied since: *

Current deductable on policy: *

$500

$1,000

$1,500

$2,000

Is there smoking in the home?: *

Yes

No

Any home business operations?: *

Yes

No

If yes, home business details:

Is there a mortgage on the home?: *

Yes

No

If yes, with who?: *

Connected monitored alarm system? *

Yes

No

If yes, please advise (request certificate): *

Local

Cental

Partial

Full

Fire protection:

Hydrant

Fire Hall**

Unprotected

Shuttle Tanker

**How many kilometers is the fire hall from the dwelling?:

Update Details

ROOF

Roof Age: *

Roof Type: *

Asphalt

Clay

Cedar

Steel

Metal

ELECTRICAL

Electrical Age: *

Electrical Type: *

AMPS

Fuse/Breakers

PLUMBING

Plumbing Age: *

Plumbing Type: *

Copper

ABS Plastic

Galvanized

Steel

FURNACE

Furnace Age: *

Auxiliary Heat Source:

Woodstove

Fireplace

Direct Vent Insert

Source

Natural gas

Oil

Wood

Propane

Dwelling Details

Structure Type: *

Detached

Semi

Townhouse

Apartment Building

Exterior Construction: *

Brick Veneer

Aluminum

Fire Resistive

**Other

**If other, please specify:

Total Square Footage: *

Number of Full Baths: *

Number of Half Baths: *

Garage: *

Yes

No

Garage Type:

Attached

Carport

Built-In

Number of Garages: *

Number of Cars: *

Finished Basement: *

Yes

No

Sump Pump: *

Yes

No

Back Flow Valves: *

Yes

No

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