Business Insurance

Name

City/Province

Phone Number

Age of building

Is the building sprinklered?

Yes

No

Are you the only tenant?

Yes

No

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

Yes

No

What type of business

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

Address

Postal Code

Email

Construction of building

How much area do you occupy?

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

Yes

No

Has insurance ever been denied or canceled:

Yes

No

How many years in business?

What are the annual receipts?

What is the annual payroll?

Thanks for submitting!

ADDRESS

PO Box 179
3 South Water Street
Coboconk, ON
K0M 1K0

PHONE

Phone: 705-454-3387
Toll Free: 800-250-8844
Fax: 705-454-1998

EMAIL

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