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On-Line Renters
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!
Your Personal Data:
 
Your Name:
Property Address:
City:
Province:
Postal Code:
E-Mail (REQUIRED):
Phone: (REQUIRED)
Fax (optional):
 
 
Dwelling Information
 
Year Home Built:
Home Square footage:
 
Is there a woodstove? NO YES
 
How many cords of wood do you burn per year:
 
Number of units: 1 family Duplex
 
Does Your Home Have a Basement? None
Basement
Crawlspace
Finished
Slab, No Basement
 
Prominent Exterior Wall Construction: Frame
Brick/Veneer
Stone
Stucco (list in remarks)
 
Type Roof: Shingle
Wood Shake
Tar/Gravel
Metal Other
 
Number of stories: One 1.5
Two Three
 
Do you have an in-home business or daycare? Yes No
If yes, list type of business / # of children:
Do you have a monitored burglar alarm system? Yes No
If yes, list type/for dogs, list breed:
 
Are You Near Brush Area? Yes No
 
# of feet to nearest
fire hydrant: 		# of miles to nearest
fire station:
 
Currently Insured? Yes No
Name of Carrier & how long insured?
 
Prior Claims in last 3 years? Yes No
Describe claims in detail:
 
Has any insurer cancelled or refused you insurance in the last 3 years? Yes No
 
Primary Policyholder's Birthdate:
(Some companies products
offer discounts for certain age groups.)
 
Plumbing type: Copper Galvanized
Mixed (Copper/Galvanized)
 
 
Heating Type: Gas
Propane
Oil (if oil, list tank location in remarks)
 
Circuit Breakers or fuses? Breakers Fuses

# Bedrooms: # Bathrooms:
 
# Fireplaces: # Chimneys:
 
Special features
(i.e., deck, air conditioning, alarm systems, pool, etc.)
 
Coverages:
 
Personal Property
$ 		Liability Coverage
$
 
Comments/Remarks
(describe any scheduled jewelry, in-home business, oil tank location, or other special coverages/remarks here):
 
Send my quotation via: E-Mail Fax
Regular Mail
Call Me By Phone
Thank you for filling out this form COMPLETELY!

You are applying for tenant insurance based on the information provided above as well as any information that may be available from reports ordered on your tenant insurance. This information may include insurance claims, non-payments and cancellations. You authorize needcarinsurance.ca to collect and disclose information as permitted by law and required by insurance companies for the purposes necessary to assess your application for new or renewal tenant insurance, investigate and settle claims and detect and prevent fraud. You also agree that needcarinsurance.ca may collect and use this personal information to consider your on-going needs for insurance products and information. You understand that your personal information may be disclosed pursuant to any relevant privacy laws or other laws.

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Contact Us Today at:
 McLean Insurance Protection Team, Inc.
58 Foster St., Perth, Ontario, K7H 1S1 (across from Scotiabank)
Toll Free: 1-800-267-7928 / Local Phone: 1-613-267-5100
Fax Number: 1-613-264-0663
E-Mail us at: quotes@mcleaninsurancelive.com

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