Home Insurance Quote Form
Please provide the following preliminary information to start the quoting process:
* indicates a required field
Type of policy *
Owner Occupied Condo/Townhouse
Location Address *
Full Legal Name(s) of Owners *
New purchase or Renewal quotation? *
Completion or Renewal date (YYYY-MM-DD) *
Do the client(s) give the Insurers authorization to use a ‘Soft Credit score check’ for possible discounts & best available rates?
If you have a copy/photo of your current policy on hand, you can attach it here so our agents can see your current forms, coverages & limits to provide a comparable quotation.
By selecting ‘Yes’, I am providing personal information of individuals in this form to apply for insurance. The personal information collected will be used for the purpose of this application or any renewal or change in coverage. I consent and authorize my broker, agent or insurer to the following:
i) To collect, use and disclose personal information on this form to, from and between insurers and other appropriate parties, subject to my broker's, agent's and the insurer's policy regarding personal information. Such personal information will include policy history, loss history and rating information.
ii) That these collections, uses and disclosures are for the purposes necessary to communicate with me and the listed applicants, assess, manage and underwrite risk, determine a premium, determine eligibility and conditions for a premium payment plan, investigate and settle claims, analyze business results, detect and prevent fraud, as permitted by law.
iii) To collect only my personal credit information including my credit score from consumer reporting agencies, as permitted by law for the purposes identified above. I understand that my consent for the use of credit information remains valid until withdrawn by me in writing. By withdrawing or failing to provide my consent to the use of credit information, I understand that I may not benefit from the best rate available to me.
I declare that all individuals whose personal information is contained in this form have authorized me to consent to i) and ii) above on their behalf. I may obtain a copy of or ask questions about my broker's, agent's or insurer's personal information policies by contacting their respective privacy officers.