To get a no-obligation quote on your small business insurance, please complete the following form and submit it to our office. We will contact you within the next two business days. Please note: we can only provide insurance for residents of Ontario, Canada. We only serve the Ottawa region.
Tell us about yourself...
Please Note: It is imperative that all fields be completed for us to give you an accurate quote.
Name:
Address:
City:
Province:
Postal Code:
Phone:
E-mail:
Have you ever had your insurance cancelled or refused?
Yes No
Do you currently have insurance through another company?
If yes, what is the name of the insurance company?
What is your insurance policy #?
If you like our quote, when would you want the coverage to start?
Tell us about your business...
Is your business a:
Retail Store Office Contractor Other
What is your product/service:
How long have you been in business?
What are your annual sales:
< $100,000 $100,000-$250,000 $250,000-$500,000 $500,000-$1,000,000 > $1,000,000
What percentage of your sales are outside Canada?
What percentage of your sales are in the U.S.? Europe Other
Number of employees:
Just me 2-5 6-10 11-25 > 25
Do you currently insure your business?
Please provide us with a complete description of your operations:
Tell us about your property...
When was it built:
Is it in a:
House Single Building Strip Plaza Enclosed Mall High Rise Tower
Is it sprinklered:
Are the walls:
Brick/Block Concrete Wood Frame Plaster/Stucco Other
Are the floors:
Wood Steel Concrete
Is the roof:
If it is over 20 years old, have any of these been updated or replaced:
Furnace Roof Wiring Plumbing
Is there an alarm system:
None Burglar Only Fire Only Burglar & Fire
If yes, is it:
Local Only Monitored by company
Is your property located within:
300m of Fire Hydrant 8 km of Fire Hall Neither
Coverages & Deductibles
Please fill in the coverages you presently have. The best place to find this information is on your current insurance policy. If a section does not apply to you, please leave it blank or fill in "n/a". If you are uncertain of an answer, mention it in the comment section at the bottom.
Basic Coverages
Building Amount:
$
Stock Amount:
Equipment Amount:
Liability Amount:
$1,000,000 $2,000,000 $5,000,000
Deductible:
$500 $1,000 $2,500
Below are some popular optional coverages. Some of our small business packages include many of these. However, the included limits may be different than your existing policy. There are also many others not listed below. Please check the coverages in your policy carefully to ensure our quote will match your existing coverages. Anything not listed below should be mentioned in the comment section.
Optional Coverages
Business Interruption:
Profits:
Gross Earnings:
Extra Expense:
Outdoor Signs:
Business Tools:
Exterior Glass:
Boiler & Machinery:
Claims Information
Type of Claim:
Date of Claim mm yyyy
1.
None Break-in Fire Jewelery Lost/Stolen Water Damage Other
2.
3.
Comment:
Your Privacy You are authorizing that we collect, use or disclose your personal information contained on this information form as well as any additional information that we may obtain about you and other listed beneficiaries based on the information you have disclosed to us, (for example confirming your claims history or checking with motor vehicle agencies), for the purpose of providing you with this quote. By submitting this information form you also confirm that you have obtained the permission of all other potential beneficiaries listed on this information form for the collection, use and disclosure of their Personal Information for the purpose of providing you with this quote. Submission of this form does not constitute an application for insurance. Do you consent? Yes No
Thank you for taking the time to fill out this form. Select the "Submit" button below and we will contact you within the next two business days. Our quote will include the coverages you selected. We will include the cost of popular optional coverages with our quotation.
* Coverage is subject to the insurer's underwriting policies.
