Select a Language ------------- English Français Hochdeutsch     Vegas Draw     Contact Us     Links     Home     ABOUT US BASIC INSURANCE SPECIALTY INSURANCE FORMS QUOTES Home Quote Request Name: * Birthdate:  Email address: Home Phone: Work Phone:  Street: City: Province: Postal: House Information Year Built: Square footage: Present Carrier: Expiration Date: Years Insured: Mortgage: < Occupancy: Primary Secondary Seasonal Rental Under Construction Structure Type: Detached Semi-detached Townhouse Mobile Home Mini Home Duplex Triplex Apartment Construction:  Frame Brick veneer Masonry Apt. Fire Resistive Stories: 1 2 3 4 Protection: within 300m of hydrant within 8 km of firehall unprotected Heating - Primary:  Natural Gas Furnace Electric Oil Furnace Combination with wood Combination without wood Furnace(central) with add-on wood burning unit Fireplace Insert Other Heating - Auxillary: Natural Gas Furnace Electric Oil Furnace Combination with wood Combination without wood Furnace(central) with add-on wood burning unit Fireplace Insert Other Burglar Alarm: No Yes Smoker: Yes No Amount of Coverage desired: Replacement Cost of Home: Deductible Requested: $200 $500 $1000 If home over 20 years old then when was: Electrical updated:  Heating updated:  Plumbing updated:  Roof updated: Claims History List any claims within last five years: Date: Description: Comments Any other comments you have put here: Legal © Copyright 2008 BSI Insurance Brokers Ltd.                                 Sitemap