Homeowners Proposal

Click to open/close each section and enter required information. Time to complete: less than 5 minutes

Step # 1 of 5 - Personal and contact information

COMPLETE SECTION # 1 - PERSONAL INFORMATION - Canadian Residents

Your contact information will be kept private and secure.

Thank you for requesting a Homeowners Quote from Wilson Insurance. Simply complete the following form for a FREE No Obligation Quote. Let us know how you prefer to be contacted and an Account Executive will be in contact to explain coverage options and your quote.

By clicking the Submit Button you are agreeing to the Terms & Conditions of doing business with our brokerage via the Internet.
Click here to view the Terms & Conditions.

First Name: *

Last Name: *

Daytime telephone number: *

Email address: *

What is the best way to contact you: *

Step # 2 of 5 - Current insurance information

COMPLETE STEP # 2 - CURRENT INSURANCE INFORMATION

Current insurance company: *

Current policy expiration date:

How long have you had Homeowner's Insurance: *

How long have you lived at your current home: *

Have there been any claims filed for this property in the past 10 years: *

Have you filed any claims at any location in the past 10 years: *

Current coverage on your residence:

What is your current deductible:

How much liability coverage do you currently have?:

Step # 3 of 5 - Property information on the home you want quoted

City, Province: *

COMPLETE STEP # 3 - PROPERTY INFORMATION

Street Address: *

Postal Code: *

How long have you had this property continuously insured: *

Are there any loans on the property:

How is the property used:

Type of structure:

Year built: *

Number of Stories: *

Total living area (not including finished basement) or house dimensions:

Foundation: *

Area of Deck: square footage

Area of Enclosed Porch: square footage

Area of Open Porch: square footage

Finished attic: square footage

Sunroom/Solarium: square footage

Exterior -- Primary type:

Exterior -- Secondary type:

Type of roof: *

Age of roof: * years old

Heating -- Primary Source of Heat:

Heating -- Secondary Source of Heat:

Type of chimney:

Type of Garage:

How many bathrooms: *

Swimming pool -- Type:

Swimming pool -- Liner:

Swimming pool -- Value: $

Do you have central Air Conditioning: *

Do you have any of the following:

	Yes	No
Cental Vac System
Burglar or Fire Alarm
Air Exchanger
Whirlpool Bath
Hot Tub
Skylight
Bay/Bow Window
Palladian Window
Fixed Picture Window
Cathedral Ceiling

Type of electrical system: *

Distance from fire hydrant (Metres): *

Distance from fire hall (Kilometres): *

For potential age discount, confirm date of birth:

Are there any apartments or businesses located in the home: *

If the dwelling is over 25 years old, describe the updating with respect to the year updated and what was completed for plumbing, heating, wiring and roofing.

Updates:

Step # 4 of 5 - Protection Review

COMPLETE SECTION # 4 - PROTECTION REVIEW

In order to properly protect your assets, its important that we have complete information about your total account.

Provide information on the following:

	No	Yes
Do you have a vacation home?
Do you have rental property?
Do you have household members away at school?
Is the property prone to flooding or located in a designated flood plain?
Is business or farming conducted on the property?
Do you have any income-producing hobbies?
Do you have any art, guns or collectibles?
Do you have jewelry that you would want replaced if it were lost or stolen while on vacation?
If you sewer backed up and your carpet was ruined, would you want it replaced?
In the event of death, would you want the mortgage on your home paid off?
Do you have an inventory of your household possessions?
Would you prefer to lower your premium by choosing a higher deductible?
Do you have any recreational vehicles such as boats or snowmobiles?
Do you have coverage for Identity Theft Restoration?
If you were sued for $1,000,000 or more because you were at fault in an auto accident, or someone got hurt on your property, would you expect your insurance to pay?
If you had a chronic illness that left you unable to care for yourself for an extended period or time, do you expect to be covered by insurance?

When does your auto policy expire:

Who is your current company for auto insurance:

Step # 5 of 5 - Comments and approval

COMPLETE SECTION # 5 - COMMENTS & APPROVAL

Comments and questions:

How did you hear about us?:

By clicking submit below you agree the information you have submitted to be accurate and request Wilson Insurance to contact you with a no-obligation homeowners quote. We thank you for choosing Wilson Insurance and offering us the opportunity to provide you with a quote.

	5%	10%	15%	20%	25%	30%	35%	40%	45%	50%	55%	60%	65%	70%	75%	80%	85%	90%	95%	100%
Hardwood
Ceramic
Carpet
Vinyl
Laminate
Other