Cassidy & Young Home Quote

Personal

First Name *

Last Name *

Home Phone *

Mobile Phone

Email *

Address *

City *

Province *

Postal Code *

Requested Effective date or the Expiry date of your current policy? *

Type of Policy *

Name of Group or Employer *

How did you find out about our program?

Prior Insurance and Claims

Years of prior home or tenant insurance?

Did you file any claims or losses in last 5 yrs?

Yes

No

Home Information

Year Build

When did you move into this house?

Square footage of your house? *

Any Mortgages *

Yes

No

Number of Mortgages

Is the basement finished? *

Yes

No

Percent of Basement finished?

Do you have a Deck? *

Yes

No

Deck square footage?

Do you have a Pool? *

Yes

No

Pool Type

Ground

Inground

Alarm System? *

Yes

No

Monitored? *

Yes

No

Electrical AMP service?

60 AMP

100 AMP

200 AMP

Year of Most Recent Update

Heating

Roof

Wiring

Plumbing

Occupants

Many companies use credit score information to determine your premium and it can lead to a major discount. It is only a “soft hit” check on your credit score.

Please indicate if you give permission to run this soft hit on your credit score? *

Yes

No

Date of Birth of oldest occupant? *

Are You Human? *

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