Some types of commerical insurance policies are highly specialized to the particular industry of the business. This quote request form only obtains some basic necessary information about your business, but a separate application specific to your particular business may also be required. Please complete our online questionnaire below (or a PDF verison can be found here), and we will contact you with any additional questions or applications necessary to obtain a quote for your business. Please note: the information that you provide in this questionnaire will be used to determine your premiums and eligibility for insurance, and you are responsible for the accuracy of the answers you provide. If you falsely describe or fraudulently omit any fact that is material to the insurance company in order for it to be able to judge the risk, your insurance policy may be void. Please ensure that you fully understand the answers that you are providing when completing this questionnaire; if you are unsure of some of these details, we strongly recommend that you obtain professional advice. You are welcome to contact our office with any questions you have about this questionnaire. Name of Person Applying: Business Name (if applicable): Email Address: Phone Number: Business Location Address: Mailing Address (if different): City: Province: Postal Code: How is this business structured?: Individual/ProprietorshipPartnershipCorporation/Limited Liability Company What type of business: Retail Office Commercial Building Ownership Personal Services (salon/spa) Professional Services Food/Beverage Contractor Farm Manufacturer Garage Operation Wholesale Operation Other Please describe your business operations in detail (what products or services you offer): What are the gross annual receipts: Up to $10,000 $10,000 to $25,000 $26,000 to $50,000 $51,000 to $100,000 $101,000 to $200,000 $201,000 to $300,000 $301,000 to $500,000 $501,000 to $1,000,000 Over $1,000,000 Gross receipts means total income BEFORE expenses are deducted. If this is a new venture, please indicate your estimate for the next 12 monthsHow many years in the business: New startup 1 - 2 years 3-5 years > 5 years How many years of experience do you have in this line of work: Has insurance ever been denied or cancelled: YesNo Have there been any losses or claims in the last 5 years: YesNo Have you had any business insurance in the past: YesNo Expiry date of your current insurance policy: CalendarToday mm/dd/yyyyDo you own or rent your location: OwnerTenant Are you the only occupant/tenant of the building: YesNo Age of Building: < 1 year 1 - 20 years 20 - 35 years > 35 years Construction of building: Frame Masonry/Non-Combustible Fire Resistive Type of Heat in the building: None Natural Gas Electric Propane Oil Wood Other How much area do you occupy: < 1,000 sqft 1,000 - 5,000 sqft 5,000 - 10,000 sqft > 10,000 sqft Is the building sprinklered: YesNo Is there a fire hydrant within 500 ft. (150 metres): YesNo Is there a fire hall within 3 miles (5 kms): YesNo Which coverages are you interested in obtaining (indicate all that apply): Liability Only (no coverage for physical assets)Building CoverageEquipment/Tools CoverageCoverage for Stock/Goods for SaleOffice Contents/ComputersGeneral Liability (Injury/Property Damage to others)Professional Liability (Errors & Omissions)Business Interruption (Loss of earnings)Crime (Loss of Money)Equipment BreakdownCyber/Data CoverageCargo Coverage Security code: Please note, email is not a secure method of transmitting sensitive personal information and by using this service you accept this risk. If you are concerned, you may use an alternative method. Share this