Home Insurance Quote February 16, 2016by JWDavis Home Insurance Step 1 of 5 20% 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?*YESNONUMBER OF MORTGAGES*Private Mortgage?*YesNoPRIOR 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:*ANY CANCELLATIONS FOR NON-PAYMENT IN THE LAST 3 YEARS?YesNoThird ChoiceCLAIMS IN THE LAST 5 YEARS:*012345PRIOR CLAIMS: (PLEASE GIVE DATES AND DETAILS) PLEASE ENTER IN ALL DATES AND AMOUNTS WHAT YEAR WAS THE HOUSE BUILT?*WHAT IS THE TOTAL SQUARE FOOTAGE OF THE HOUSE? (EXCLUDING BASEMENT)*IS THE BASEMENT FINISHED?YesNoWHAT IS THE SQUARE FOOTAGE OF THE BASEMENT?WHAT PERCENTAGE OF THE BASEMENT IS FINISHED?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 13km ELECTRICALAMPERAGE*PLEASE SELECT60100200OtherBREAKER OR FUSE*PLEASE SELECTBREAKERFUSETYPE*PLEASE SELECTCopperAluminiumKnob and TubeYEAR UPDATED*HEATINGTYPE OF HEATING*PLEASE SELECTElectricNatural GasOilPropaneYEAR 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 WALLSMUST ADD UP TO 100%CONCRETE BLOCK / MASONARY0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%WOOD SIDING – WOOD FRAME0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%SOLID BRICK0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%BRICK VENEER – WOOD FRAME0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%STONE VENEER – WOOD FRAME0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%SOLID STONE0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%VINYL SIDING – WOOD FRAME0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%STUCCO ON FRAME0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%ALUMINIUM SIDING0%5%10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%85%90%95%100%ROOFING*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?NOYESDECK SQ FOOTAGECLOSED BREEZEWAYBALCONYDECKINPUT SQFTDO YOU HAVE A PORCH?NOYESPORCH SQ FOOTAGEOPEN PORCHCLOSED PORCHOPEN BREEZEWAYINPUT SQFTDO YOU HAVE A PATIO?NOYESTYPE OF PATIO Interlocking Brick Concrete Slab PATIO SQ FOOTAGEPATIO 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?NOYESHOT TUB SIZESOFT-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 & BOTTOMSWIMMING POOL SIZEBUILT-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?YesNoNotesARE THERE ANY RENOVATIONS OR CONSTRUCTION CURRENTLY GOING ON?YesNoESTIMATED COSTDO YOU PLAN ON OFFERING ANY SHORT TERM RENTALS?YesNoHOW DID YOU HEAR OF JW DAVIS INSURANCE BROKERS?Section Break
