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Capital Insurance Brokers – Home Quote
Property insurance quote with
Capital Insurance Brokers
1
Insured info
2
Dwelling info
3
Contact info
Name of Insured
First
Last
Date of Birth (MM/DD/YYYY)
MM
DD
YYYY
Is there a co-applicant?
No
Yes
Name of Co-applicant
First
Last
Date of Birth of Co-applicant (MM/DD/YYYY)
MM
DD
YYYY
What type of policy would you like a quote for?
*
Homeowner
Condominium
Tenant
Address
*
Street Address
City
Postal Code
How far is your residence from the nearest fire hydrant?
Within 1000 feet (300m)
Over 1000 feet (300m)
How far is your residence from the nearest firehall?
Within 8 km
Between 8 km to 13 km
Over 13 km away
How many years have you had residential insurance?
Please choose
Less than 1 year
More than 1 and less than 2 years
More than 2 and less than 3 years
More than 3 and less than 4 years
More than 4 and less than 5 years
More than 5 and less than 6 years
Over 6 years
How many residential insurance claims have you had in the past 6 years?
None
1 claim
2 claims
3 or more claims
Dwelling Information - Home
Please enter the year the dwelling was built:
Please enter the square footage of the dwelling:
How much is this dwelling building currently insured for? (Leave blank if you're not sure)
What is the structure type of the dwelling?
Detached house
Duplex
Triplex
Townhouse
Other than your own family, do you have renters/roomates living here?
No
Yes
Is there a burglar alarm in place?
No
Yes
Is there an alarm system in place that monitors for smoke and fire?
No
Yes
Dwelling Information - Condo
Please enter the year the dwelling was built (approximately):
What is the structure type of the building?
Detached house
Duplex
Triplex
Townhouse
Low-rise Apartment building (up to 3 floors)
High-rise Apartment building (4+ floors)
What is the construction type of the building?
Not sure
Wood frame
Brick/masonry
Fire resistive
Other than your own family, do you have renters/roomates living here?
No
Yes
How much contents coverage do you require?
Not sure
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$55,000
$60,000
$65,000
$70,000
$75,000
$80,000
More than $80,000
Dwelling Information - Tenant
What is the structure of the building?
Detached house
Duplex
Triplex
Townhouse
Low-rise Apartment building (up to 3 floors)
High-rise Apartment building (4+ floors)
What is the construction type of the building?
Not sure
Wood frame
Brick/masonry
Fire resistive
Other than your own family, do you have renters/roomates living here?
No
Yes
How much contents coverage do you require?
Not sure
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$55,000
$60,000
$65,000
$70,000
$75,000
$80,000
More than $80,000
Who should we contact regarding this quote?
*
First
Last
Home/cell phone number:
*
Business/work number:
Email:
*
When would be the best time for a broker to contact you with your insurance quotes?
*
Anytime
Morning (9:00 am to 11:59 am)
Afternoon (12:00 pm to 4:30 pm)
Evening (4:30 pm to 8:00 pm)
By clicking "Get Quotes", I understand that the information from this form will be provided to a licensed insurance broker with Capital Insurance. I also understand that a broker may contact me via phone or email to provide quotes or to obtain additional information needed to provide quotes.
*
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