The Insurance Exchange - London Ontario Insurance
Home Insurance Quote
First Name:
Last Name:
Street Address:
City:
Province:
Postal Code:
Home Telephone Number:
Work Telephone Number:
ext
Email:
Type of Property
Home Owner
Condo Owner
Renting
Have you had any personal property claimed in the past 3 years?
Yes
No
Have you had any cancellations for non-payment in the past 3 years?
Yes
No
Age of Insured
Non-Smoker?
Yes
No
Is your property located within 300 m (1000 ft) of a fire hydrant?
Yes
No
Is your property located within 8 km (5 miles) of a fire hall?
Yes
No
Policy Deductible Preferred
:
--Select--
$300
$500
$1000
Liability Amount Requested:
--Select--
$500,000
$1 million
$2 million
Estimated replacement value of personal property (condo and renters only)
FOR HOMEOWNERS ONLY
Present insured value
Estimated replacement value of dwelling
Morgage on Home
Yes
No
Year Built
Square footage of Ground Floor
Type of Dwelling:
--Select--
Ranch
Raised Ranch
Split Level
Two Story
Construction of Dwelling
Percentage of Basement Finished:
--Select--
Unfinished
25%
30%
50%
75%
100%
Extra Bathrooms:
--Select--
1/2
1
1 1/2
2
Central Air
Yes
No
Porches:
--Select--
Open
Enclosed
None
Square Footage:
Deck
Yes
No
Square Footage:
Garage type:
--Select--
None
Attached
Detached
Size:
--Select--
1 Car
1 1/2 Car
2 Car
3 Car
Woodstove
Yes
No
Manufacturer:
Year Built:
Cords of Wood Per Year:
Type of Heat
Year Updated:
Type of Wiring
Year Updated:
Type of Plumbing
Year Updated:
Type of Roof
Year Updated:
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