Business Insurance

Name:

Email Address:

Address:

City:

Province:

Postal Code:

Phone Number:

Age of Building:

Construction of building:

Roof Construction:

Is the building sprinklered:

How much area do you occupy(including basement):

If basement, is it finished or unfinished:

Number of Stories (excluding basement):

Building Type:

Are you the only tenant:

Is there a hydrant within 500 ft. (150 metres):

Is there a fire hall within 3 miles (5 kms):

Has insurance ever been denied or canceled:

What type of business:

How many years in the business:

Have there been any insurance claims in the last 3 years:

What are the annual receipts:

What is the annual payroll:

Comments:

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