Home Insurance Quote - JW Davis Insurance Brokers

Home Insurance

Step 1 of 5

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 Province Postal Code
PHONE:
Telephone Number:*
E-MAIL:*
OCCUPATION:*
SMOKER / NON-SMOKER?*
HOW LONG HAVE YOU RESIDED AT THIS LOCATION?*
DO YOU CURRENTLY OR PLAN TO RENT THIS PROPERTY TO OTHERS?*
CLOSING DATE:*
Date Format: YYYY dash MM dash DD
NUMBER OF MORTGAGES*
PRIOR INSURANCE INFORMATION (IF APPLICABLE)
DO YOU HAVE PRIOR INSURANCE*
CURRENT 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:
PRIOR 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:*
NUMBER OF STOREYS:*
STYLE*
FOUNDATION/BASEMENT WALL TYPE*
SITE ACCESS*
DISTANCE FROM HYDRANT*
DISTANCE FROM FIREHALL*

ELECTRICAL
AMPERAGE*
BREAKER OR FUSE*
TYPE*
YEAR UPDATED*
HEATING
TYPE OF HEATING*
YEAR UPDATED*
PLUMBING
PLUMBING*
YEAR UPDATED*
HOT WATER TANK
HOT WATER TANK
YEAR UPDATED*

EXTERIOR DOOR TYPE*
EXTERIOR WALLS*
ROOFING*
YEAR UPDATED*
FLOORING
MUST ADD UP TO 100%
CARPET, NYLON
CARPET, WOOL
VINYL TILE, 12” x 12”
VINYL SHEET, ROLL
CERAMIC TILE
SLATE / STONE TILE
HARDWOOD, LAMINATE
HARDWOOD, PARQUET
HARDWOOD, SOLID WOOD
BATHROOMS – MAIN HOUSE
2 PIECE – SINK, TOILET
3 PIECE – SINK TOILET, SHOWER IN TUB
4 PIECE – SEPARATE SHOWER AND TUB
CEILINGS- SHOULD ADD UP TO 100%
CATHEDRAL CEILINGS
9 FOOT CEILINGS
8 FOOT CEILINGS
SQ. FT. FINISHED ATTIC*

DECK / PORCH / PATIO
DO YOU HAVE A DECK?
CLOSED BREEZEWAY BALCONY DECK
INPUT SQFT
DO YOU HAVE A PORCH?
OPEN PORCH CLOSED PORCH OPEN BREEZEWAY
INPUT SQFT
DO YOU HAVE A PATIO?
PATIO COVER PATIO – INTERLOCKING BRICKS PATIO – POURED CONCRETE PATIO – CONCRETE TILES
INPUT SQFT
FIREPLACES
NUMBER OF FIREPLACES
WOOD BURNING, 1 STOREY CHIMNEY
WOOD BURNING, 2 STOREY CHIMNEY
WOOD BURNING, 3 STOREY CHIMNEY
FIREPLACE, INSERT - STEEL
FIREPLACE, INSERT – CAST IRON
WOODSTOVE – STEEL
WOODSTOVE – CAST IRONGAS, DIRECT VENT, 33” – 36” WIDE
GAS, DIRECT VENT, 33” – 36” WIDE
GAS, DIRECT VENT, 42” – 46” WIDE
GAS, DIRECT VENT, MULTISIDE
SKYLIGHTS
DO YOU HAVE SKYLIGHTS?
FIXED - 24 x 24
FIXED – 24 x 48
OPERATING – 24 x 48
MULTI-FAMILY UPGRADES
ADDITIONAL KITCHEN
ADDITIONAL ENTRY AND EXIT
SEPARATE HEATING UNIT
SEPARATE ELECTRICAL SERVICE
GARAGES*
# OF CARS*
DETACHED STRUCTURE
VALUE
SUMP PUMP (OR SIMILAR DEVICE)
SUMP PUMP WITH BACK UP BATTERY
CENTRAL A/C – SAME DUCTS
RADIANT FLOOR HEATING SYSTEM
INTERIOR SPRINKLER SYSTEM
DO YOU HAVE HOT TUBS?
SOFT-SIDED PORTABLE
FREE-STANDING - SMALL
FREE-STANDING - MEDIUM
FREE-STANDING - LARGE
BUILT-IN - SMALL
BUILT-IN - MEDIUM
BUILT-IN - LARGE
SWIMMING POOLS
BUILT-INS
CENTRAL VACUM SYSTEM
COMPACTOR
DISHWASHER
ELECTRONIC AIR FILTER
GARBAGE DISPOSAL
GARAGE DOOR OPENER
JACUZZI / JETTED TUB
INTERCOM SYSTEM
ICEMAKER
MONITORED BURGLAR ALARM SYSTEM
MONITORED FIRE ALARM SYSTEM
OVEN
RANGE HOOD
SMOKE DETECTORS
WATER SOFTENER
WET BAR
SPECIAL LIMIT ITEMS
SILVERWARE
INPUT VALUE
JEWELLERY
INPUT VALUE
FUR
INPUT VALUE
ARTWORK
INPUT VALUE
SCRULPTURES
INPUT VALUE
COMIC BOOKS
INPUT VALUE
SPORTS MEMORBILIA
INPUT VALUE
COLLECTOR CARDS
INPUT VALUE
STOCKS & BONDS
INPUT VALUE
STAMPS
INPUT VALUE
COIN
INPUT VALUE
SOFTWARE
INPUT VALUE
BUSINESS BOOKS & TOOLS
INPUT VALUE
WATERCRAFT
INPUT VALUE
ADDITIONAL INFORMATION
Soft 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?
Notes

09:00 – 17:00

Mississauga,

905-822-9660

09:00 – 17:00

Mississauga,

905-822-9660

Home Insurance

Step 1 of 5

ELECTRICAL

HEATING

PLUMBING

HOT WATER TANK

FLOORING

BATHROOMS – MAIN HOUSE

DECK / PORCH / PATIO

FIREPLACES

SKYLIGHTS

MULTI-FAMILY UPGRADES

BUILT-INS

SPECIAL LIMIT ITEMS