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Business Insurance

Name:
Email Address:
Address:
City:
Province:
Postal Code:
Phone Number:
Age of Building:	< 1 year 1 - 20 years 20 - 35 years > 35 years
Construction of building:	Frame Masonry Non-Combustible Fire Resistive
Is the building sprinklered:	YesNo
How much area do you occupy:	< 5,000 5,000 - 10,000 > 10,000
Are you the only tenant:	YesNo
Is there a hydrant within 500 ft. (150 metres):	YesNo
Is there a fire hall within 3 miles (5 kms):	YesNo
Has insurance ever been denied or canceled:	YesNo
What type of business:	Retail Office Building Ownership Wholesale Operation Farm Service Operation Contractor Garage Operation Manufacturer Other
How many years in the business:	< 1 years 1 - 5 years > 5 years
Have there been any insurance claims in the last 3 years:	No <= 2 >= 3
What are the annual receipts:	Up to $50,000 $51,000 to $100,000 $101,000 to $500,000 $501,000 to $1,000,000 Over $1,000,000
What is the annual payroll:	Up to $50,000 $51,000 to $100,000 $101,000 to $500,000 $501,000 to $1,000,000 Over $1,000,000