Tenant Applicaton

Because of the different variables affecting your insurance premiums, we need a few pieces of information from you. To get started on your application, please fill out the following fields below. After you send it, we'll get back to you as timely as possible.

Contact Informaton --------------------------------------------------------------------------------

First Name:

Address:

City:

Province:

Postal Code:

Email Address:

Home Phone:                   (                    )

Cell Phone:                       (                    )

Fax Phone:                        (                    )

Preferred method of contact:

Insurance Informaton --------------------------------------------------------------------------------

What is the approx. replacement value of your contents?:      $

What do you live in?:

If you are in a rural location, how far is the
nearest firehall?:

What floor are you on?:

Are there sprinklers in your unit?:

Number of stories in your building?:

Date of birth:

Do you have existing insurance?:

How many claims in the past 5 years:?

Do you have any other property or special
items that require insurance coverage?:

Last Name: