Home Insurance QuoteFebruary 16, 2016by JWDavisHome Insurance Step 1 of 520%FIRST NAME ON DEED:* First Last DATE OF BIRTH:* Date Format: YYYY slash MM slash DD SECOND NAME ON DEED: First Last DATE OF BIRTH: Date Format: YYYY slash MM slash DD PROPERTY ADDRESS:* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code PHONE:Telephone Number:*E-MAIL:* OCCUPATION:*SMOKER / NON-SMOKER?*NOYESHOW LONG HAVE YOU RESIDED AT THIS LOCATION?*DO YOU CURRENTLY OR PLAN TO RENT THIS PROPERTY TO OTHERS?*YESNOCLOSING DATE:* Date Format: YYYY dash MM dash DD NUMBER OF MORTGAGES*PRIOR INSURANCE INFORMATION (IF APPLICABLE)DO YOU HAVE PRIOR INSURANCE*YesNoCURRENT INSURANCE COMPANY:NUMBER OF YEARS WITH CURRENT INSURANCE COMPANY:DATE COVERAGE SHOULD START:* Date Format: YYYY slash MM slash DD # YEARS INSURED:CLAIMS IN THE LAST 3 YEARS:012345PRIOR CLAIMS: (PLEASE GIVE DATES AND DETAILS)HOW DID YOU HEAR OF JW DAVIS INSURANCE BROKERS?PLEASE ENTER IN ALL DATES AND AMOUNTS WHAT YEAR WAS THE HOUSE BUILT?*WHAT IS THE TOTAL SQUARE FOOTAGE OF THE HOUSE? (EXCLUDING BASEMENT)*NUMBER OF FAMILIES:*123NUMBER OF STOREYS:*1 STOREY1.5 STOREY2 STOREY3 STOREYBI-LEVELTRI-LEVELSIDE-SPLITBACK-SPLITSTYLE*DETACHEDSEMI-DETACHEDINSIDE ROWTOWNHOUSE END ROWFOUNDATION/BASEMENT WALL TYPE*CONCRETECONCRETE BLOCKSITE ACCESS*STANDARD URBAN LOTZERO-CLEARACE LOTHILLSIDE LOTRURAL AREA LOTSQ FT BASEMENTDAYLIGHT (WALKOUT)SQ FT BASEMENT FINISHEDCUSTOMSQ FT SLAB% PIER FOUNDATIONSQ FT CRAWLSPACE% HILLSIDE FOUNDATIONDISTANCE FROM HYDRANT*150m300mOver 300mDISTANCE FROM FIREHALL*5km13km8kmOver 13kmELECTRICALAMPERAGE*PLEASE SELECT60100200OtherBREAKER OR FUSE*PLEASE SELECTBREAKERFUSETYPE*PLEASE SELECTCopperAluminiumKnob and TubeYEAR UPDATED*HEATINGTYPE OF HEATING*PLEASE SELECTElectricNatural GasOilYEAR UPDATED*PLUMBINGPLUMBING*PLEASE SELECTCOPPERPVCYEAR UPDATED*HOT WATER TANKHOT WATER TANKPLEASE SELECTGASELECTRICHEAT PUMPTANKLESSYEAR UPDATED*EXTERIOR DOOR TYPE*PLEASE SELECTSINGLE SOLID WOOD / METALDOUBLE SOLID WOOD / METALSINGLE SOLID WOOD / METAL WITH 1 SIDELIGHT PANELDOUBLE SOLID WOOD / METAL WITH 1 SIDELIGHT PANELSINGLE SOLID WOOD / METAL WITH 2 SIDELIGHT PANELSDOUBLE SOLID WOOD / METAL WITH 2 SIDELIGHT PANELSEXTERIOR WALLS*PLEASE SELECTCONCRETE BLOCK / MASONARYWOOD SIDING – WOOD FRAMESOLID BRICKBRICK VENEER – WOOD FRAMESTONE VENEER – WOOD FRAMESOLID STONEVINYL SIDING – WOOD FRAMESTUCCO ON FRAMEALUMINIUM SIDINGROOFING*PLEASE SELECTASPHALT / FIBREGLASS SHINGLECEDAR SHINGLES, SHAKESMETAL SHINGLE / TILEMETAL PANEL ROOFTAR AND GRAVEL DECKCLAY TILE / SLATEYEAR UPDATED*FLOORINGMUST ADD UP TO 100%CARPET, NYLON0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%CARPET, WOOL0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%VINYL TILE, 12” x 12”0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%VINYL SHEET, ROLL0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%CERAMIC TILE0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%SLATE / STONE TILE0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%HARDWOOD, LAMINATE0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%HARDWOOD, PARQUET0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%HARDWOOD, SOLID WOOD0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%BATHROOMS – MAIN HOUSE2 PIECE – SINK, TOILET0123453 PIECE – SINK TOILET, SHOWER IN TUB0123454 PIECE – SEPARATE SHOWER AND TUB012345CEILINGS- SHOULD ADD UP TO 100% CATHEDRAL CEILINGS0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%9 FOOT CEILINGS0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%8 FOOT CEILINGS0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%SQ. FT. FINISHED ATTIC*DECK / PORCH / PATIODO YOU HAVE A DECK?NOYESCLOSED BREEZEWAYBALCONYDECKINPUT SQFTDO YOU HAVE A PORCH?NOYESOPEN PORCHCLOSED PORCHOPEN BREEZEWAYINPUT SQFTDO YOU HAVE A PATIO?NOYESPATIO COVERPATIO – INTERLOCKING BRICKSPATIO – POURED CONCRETEPATIO – CONCRETE TILESINPUT SQFTFIREPLACESNUMBER OF FIREPLACES012345WOOD BURNING, 1 STOREY CHIMNEY012345WOOD BURNING, 2 STOREY CHIMNEY012345WOOD BURNING, 3 STOREY CHIMNEY012345FIREPLACE, INSERT - STEEL012345FIREPLACE, INSERT – CAST IRON012345WOODSTOVE – STEEL012345WOODSTOVE – CAST IRONGAS, DIRECT VENT, 33” – 36” WIDE012345GAS, DIRECT VENT, 33” – 36” WIDE012345GAS, DIRECT VENT, 42” – 46” WIDE012345GAS, DIRECT VENT, MULTISIDE012345SKYLIGHTSDO YOU HAVE SKYLIGHTS?NOYESFIXED - 24 x 24012345FIXED – 24 x 48012345OPERATING – 24 x 48012345MULTI-FAMILY UPGRADESADDITIONAL KITCHEN012345ADDITIONAL ENTRY AND EXIT012345SEPARATE HEATING UNIT012345SEPARATE ELECTRICAL SERVICE012345GARAGES*NO GARAGEATTACHED GARAGEBUILT-IN GARAGEBASEMENT GARAGEDETACHEDCARPORT# OF CARS*0123DETACHED STRUCTUREGAZEBOCABANASHED - SMALLSHED – MEDIUM / LARGEGREENHOUSEVALUESUMP PUMP (OR SIMILAR DEVICE)012345SUMP PUMP WITH BACK UP BATTERY012345CENTRAL A/C – SAME DUCTS012345RADIANT FLOOR HEATING SYSTEM012345INTERIOR SPRINKLER SYSTEM012345DO YOU HAVE HOT TUBS?NOYESSOFT-SIDED PORTABLE012345FREE-STANDING - SMALL012345FREE-STANDING - MEDIUM012345FREE-STANDING - LARGE012345BUILT-IN - SMALL012345BUILT-IN - MEDIUM012345BUILT-IN - LARGE012345SWIMMING POOLSABOVE GROUNDINGROUND, VINYL LINED, METAL SIDESINGROUND, VINYL LINED, CONCRETE SIDESINGROUND, CONCRETE SIDE & BOTTOMBUILT-INSCENTRAL VACUM SYSTEM012345COMPACTOR012345DISHWASHER012345ELECTRONIC AIR FILTER012345GARBAGE DISPOSAL012345GARAGE DOOR OPENER012345JACUZZI / JETTED TUB012345INTERCOM SYSTEM012345ICEMAKER012345MONITORED BURGLAR ALARM SYSTEM012345MONITORED FIRE ALARM SYSTEM012345OVEN012345RANGE HOOD012345SMOKE DETECTORS012345WATER SOFTENER012345WET BAR012345SPECIAL LIMIT ITEMSSILVERWAREINPUT VALUEJEWELLERYINPUT VALUEFURINPUT VALUEARTWORKINPUT VALUESCRULPTURESINPUT VALUECOMIC BOOKSINPUT VALUESPORTS MEMORBILIAINPUT VALUECOLLECTOR CARDSINPUT VALUESTOCKS & BONDSINPUT VALUESTAMPSINPUT VALUECOININPUT VALUESOFTWAREINPUT VALUEBUSINESS BOOKS & TOOLSINPUT VALUEWATERCRAFTINPUT VALUEADDITIONAL INFORMATIONSoft Credit Checks can often have a favourable effect on your insurance premium. Please note Soft Credit Checks are performed by all insurance companies. Would you agree to have a Soft Credit Check on this quote?Would you agree to have a Soft Credit Check on this quote?YesNoNotes