Quotes

Home Insurance

Please take a few minutes to fill in the basic application below and we will start working to help you find better value for your property insurance dollars.

Out of respect for your confidentiality, we do not ask for all relevant information over the internet. A Haber Blain Insurance Professional will call you within 1 - 2 business days to discuss your personal needs in slightly more detail in order to give you a comparision quote over the phone.


Name:
Address:
City:
Province:
Postal Code:	(X1Y 2Z3)
Phone Number:	(123-456-7890)
Fax Number:	(123-456-7890)
Email Address:	(xxx@yyyy.zzz)
Preferred contact method:	Email Telephone
Expiry Date of Current Insurance:

Building Information
Age:
# of Families:
Type:
Construction:

Type of Coverage
Do you own your own home, own a condo unit or rent?	Homeowner Apartment or Tenant Condo
Value of Home: (Homeowners Only)
Value of Contents: (Condo or Tenants Only)
Deductible:

# of Claims in the last 5 years:
Do you have a fire hydrant within 1,000ft of your home?	Yes No
Do you have a wood burning stove?	Yes No
Do you qualify for a NON-SMOKERS Discount?	Yes No
Do you have a full service, central monitored home alarm system?	Yes No

Homes Older then 25 Years
Have any of the following Items been updated?
Electrical	Yes No
Plumbing	Yes No
Roofing	Yes No
Heating	Yes No

Your Best Insurance is an Insurance Broker