P.W. Harrison & Son Insurance
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Home Insurance
* Name:
* Address:
* City:
* Province:
* Postal Code:
* Phone Number:
* Email Address:
Have you ever had insurance cancelled
or refused?
Yes     No
Do you currently insure your property?
Yes     No
Number of years prior insurance:
Expiry date with present Insurer
(dd/mm/yyyy)
What is your date of birth? (dd/mm/yyyy)
 
Property #1 Property #2
Property type:
Use:
Do you
Year built:
If property over 20 years old, which of the following have been updated/replaced?
Furnace
Roof
Wiring
Plumbing
Furnace
Roof
Wiring
Plumbing
Is your home within vincinity of a hydrant?
Yes     No
Yes     No
Are you within 13 km of a firehall?
Yes     No
Yes     No
   
Discount Information  
I am mortgage-free
I am a non-smoker
I am claims free
I have a monitored alarm
   
Amount of current coverage  
Building:
Contents:
Liability:
Deductible:
Comments:
Select a Sales agent :
You need to select a Sales agent to continue.
   
 

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