Homeowners & Automobile Insurance Quotation Form

  • Insurance Quote Information

    Please complete the form(s) below
  • What type of insurance quote are you looking for?*

  • Policy Holder Information

  • Policy Holder 1 - Date of Birth*
     - -
  • Policy Holder 2 - Date of Birth
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Preferable time to call*
  • How did you hear about us?*
  • Do you have a preferred broker? If yes, please select:*

  • Help us better understand your property!

  • Is your property any of the following?

  • If you select any of the above please note that some additional information will need to be provided to quote. When one of our agents contacts you they will go over the required information. 

  • Home Insurance Policy Information

  • Are You Currently Insured*
  • Expiry Date of Current policy*
     - -
  • Continuous insurance since when?
     - -
  • Any Claims in the last 6 years?*

  • Property Information

  • Is this your primary home?*
  • How many KM's away is the nearest firehall?*
  • Property Type:*
  • Number of Stories:*
  • How would you describe the finishes in your home?*
  • Exterior Material*
  • Roof Material*
  • How many FULL bathrooms:*
  • How many THREE QUARTER bathrooms:*
  • How many HALF bathrooms:*
  • How many bedrooms:*
  • Is the basement developed?*
  • Is the basement a walk out?*
  • Garage*
  • How many cars?
  • Is there an attached deck or porch?*
  • Deck Materials?*

  • Property Details/ Updates

  • Heating Type:*
  • Fuel Type:*
  • Electrical Type*
  • Electrical Amperage*
  • Plumbing Type*
  • Is there a sump pump?*
  • Is there a back water valve?*

  • Other Property Details

  • Are there any wood burning units in the home?*
  • Is there a mortgage or line of credit on the property?*
  • Is there a monitored alarm on the property?*
  • Does anyone smoke in the home?*
  • Is there any business operations done on the property?*
  • Do you rent out any rooms out?*
  • Are there any dogs on the premise?*
  • Do you have a trampoline?*
  • Do you own a garden tractor?*
  • Are there any additional floaters required? example: jewelry, artwork etc.)*

  • Qualifying Additional Discount Information

  • Do you give your credit consent to Spruceland Insurance Brokers?*

  • By clicking “yes” below, you agree that Spruceland Insurance may collect and use your credit information from consumer reporting agencies to potentially apply additional discounts to your insurance quote or policy.

    Your consent will allow us to obtain your credit score, not your credit history. This verification will not affect your credit score as it is considered a “soft” inquiry by credit-reporting agencies. 

     

  • Automobile Quote Information

  • Driver Information

  • Have you continuously been insured.*
  • Are You Currently Insured*
  • If so, since when
     - -
  • Expiry Date of Current policy*
     - -
  • Date of Birth*
     - -
  • Date First Licensed(Class 5/GDL)*
     - -
  • Any claims in the last 10 years?*
  • Any license suspensions?*
  • Any traffic tickets in the last 3 years (excluding photo radar)?*
  • Do you have a Drivers Training Certificate?

  • Drivers Information

  • Have you continuously been insured.*
  • Are You Currently Insured*
  • If so, since when
     - -
  • Expiry Date of Current policy*
     - -
  • Date of Birth*
     - -
  • Date First Licensed(Class 5/GDL)*
     - -
  • Any claims in the last 10 years?*
  • Any license suspensions?*
  • Any traffic tickets in the last 3 years (excluding photo radar)?*
  • Do you have a Drivers Training Certificate?

  • Driver Information

  • Have you continuously been insured.*
  • Are You Currently Insured*
  • If so, since when
     - -
  • Expiry Date of Current policy*
     - -
  • Date of Birth*
     - -
  • Date First Licensed(Class 5/GDL)*
     - -
  • Any claims in the last 10 years?*
  • Any license suspensions?*
  • Any traffic tickets in the last 3 years (excluding photo radar)?*
  • Do you have a Drivers Training Certificate?

  • Vehicle Information

    Please fill the form below
  • Use of Vehicle*
  • Did you purchase your vehicle new or used?*

  • Coverage Options

  • Third Party Liability Limit Requested.*
  • Collision Coverage Deductible Requested*
  • Comprehensive Coverage Deductible Requested*
  • Do you require glass coverage?

  • Vehicle Information

  • Use of Vehicle*
  • Was the vehicle purchased new or used?*
  • Third Party Liability Limit Requested*
  • Collision Coverage Deductible Requested*
  • Comprehensive Coverage Deductible Requested*
  • Do you require glass coverage?

  • Vehicle Information

  • Use of Vehicle*
  • Is the vehicle new or used?*
  • Third Party Liability Limit Requested*
  • Collision Coverage Deductible Requested*
  • Comprehensive Coverage Deductible Requested*
  • Do you require glass coverage?

  • Final Information

  • Do you require additional quotes on any other properties or lines of business?
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