Agincourt Insurance Brokers Ltd


Currently Insured?
If not , then the replacement cost of your home must be calculated. Please give us a call. If you are currently insured, we will attempt to quote you based on the coverages you have now, so you can compare "apples to apples". If you haven't already, please get your current policy and answer the following questions.
Home Quote Questionnaire
Full name:	Phone #:
Address:	Fax:
City:	E-mail:
Postal Code:

Current Insurer:	Expiry Date: / /
Your Age: Age of Dwelling:	Any claims in the last five years?
If yes please provide details below:


Are you a nonsmoker?	Do you have a mortgage?
Do you have a central alarm?
Do you have any or all of the following:
Dead Bolt Locks:	Smoke detectors:
Fire extinguisher:
Coverages (please copy from current policy)
Policy form: Broad From: Comprehensive form: Don't know:
Dwelling building amount:	Contents amount:
This is a Package Policy. Personal liability, outbuildings + additional living expense are included in the package. We will detail all coverages when we quote.

Thank you for your quote request. You will have your quote within 24hrs.

INSURANCE BROKERS
ASSOCIATION OF CANADA

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