Touchstone Insurance

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Tenant

Please complete the following form in as much detail as possible in order for us to ensure the best pricing possible. We may ask for a little more information depending on your answers. One of our expert advisors will be in touch within 24 business hours.

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Basic Information
Location/Applicant Information
Dwelling Structure Information
Security Information
Coverage Options
Consent

Fields marked with ( * ) are required.
Basic Information *First name:
*Last name:
*Address:
*City:
*Postal Code:
*Main Phone:
Ext.
*E-Mail:
How did you hear about us?
Referral I am a current client Media Ad Beyond.ca Yellowpages.ca Google Other
Please let us know who referred you so we can thank them:
Please provide some additional details:
Location/Applicant Information How far is your residence from the nearest fire hydrant?
How far is the dwelling from the nearest fire hall?
What is the insured's date of birth:
Is there a co-applicant? Yes No
If yes, what is the co-applicant's date of birth?
Are all members of the household non-smokers? Yes No
How many years have you had residential insurance?
Occupation of insured? (Possible discounts)
How many claims have you had in the past 5 years?
Dwelling Structure Information Select the construction type of the dwelling.
Select the structure type of the dwelling.
Year dwelling was built?
Number of families occupying the dwelling?
Number of units in the building?
Primary heating source?
Security Information Burglar alarm?
Fire alarm?
Neighbourhood watch?
Coverage Options Contents limit?
Additional coverage requested:


Thank you for taking the time to fill out this form. Select the "Submit" button below and we will contact you by the next business day. Our quote will include the coverages you selected. We may include the cost of popular optional coverages with our quotation.

We are sorry, but we are unable to provide you with a quote at this time. Please contact us if you have any other inquiries.

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