Home Insurance Quote - M. Butler Insurance - Niagara Falls - Ontario

*All Fields are Required

Name:

Email Address:

Address:

City:

Province:

Postal Code:

Phone Number:

D.O.B. of owner or occupant:

Do you own or rent your home?

Current/Previous Policy Number

Company Dealt With

If currently insured what is the Expiry Date of you policy?

Within the past 6 years has your policy been cancelled for any reason:

Yes

If so, please explain in detail.

Do you rent out any part of your home?

Yes

If so, please explain in detail:

Estimated replacement value of dwelling (homeowner only)

Estimated replacement value of personal property (condo & renters only)

Year Built:

Year heating was updated:

Year roof was updated:

Year electrical was updated:

Year plumbing was updated:

Policy deductible preferred:

Liability amount requested:

Are there any smokers in the home?

Yes

Do you have a monitored fire alarm:

Yes

Do you operate a home business?:

Yes

Do you have a monitored burglary alarm:

Yes

Have you had any property claims in the past five years?

Yes

If so - Please explain in detail:

Do you have a mortgage?

Yes

Disclaimer
This is a request to provide a quote only and is not an insurance policy. It is not an offer of insurance. Further information may be required in order for a complete quote to be provided. This quote request contains some information about coverage offered but it does not list all of the conditions and exclusions that apply to the described coverage. The actual wording of the policy governs all situations. This quote request is only available to persons resident in the Province of Ontario. The products described are subject to change without notice at any time.

Limitation of Liability

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