Unknown 1 C Unknown - Mon, Mar 15, 2010

Anderson Insurance Agencies Ltd.

"Serving the Kootenays Since 1946"
Now also Serving Alberta
An independent insurance broker covers you best
" An independent insurance broker covers you best "

Home Insurance Quote

* Required Fields

First Name *
Last Name *
Your Birthdate (yy-mm-dd):
Employer if applicable
Mailing Address *
Street Address (if different)
City *
Postal Code *
Phone (inc. area code) *
E-Mail *
Principle Residence: Yes 
Homeowner Yes 
Tenant Yes 
Condominium Owner Yes 
Is your home within 300 meters of a fire hydrant? Yes    No 
Is your home within 8 Km's of a fire hall? Yes    No 
Year the home was built
Is there a Security Alarm installed in the home? Yes    No 
If so, is the Alarm System remotely monitored? Yes    No 
Occupation
Rented Suites or Boarders
Number of Mortgages
Type and Age of Heating:
Type and Age of Electrical:
Type and Age of Roof:
Type and Age of Plumbing:
Detached Frame? Yes    No 
Log Home? Yes    No 
Single-wide Mobile? Yes    No 
Other? Describe:
Name of Previous Insurer:
Claims in the last 5 Years:
Consecutive years Insured:
Please describe your past claims:
Any Business and/or Farm use at residence?
Home Business Rider Yes 
Type of business
Estimated gross annual sales or income
No. of employees
No. of subtrades
USA customers
$1,000,000 liability included, but choose your contents amount
Do you require higher special limits for any of the following?
Jewellry, watches and furs Amount? 
Silverware Amount? 
Bicycles Amount? 
Coins, stamps Amount? 
Business equipment Please complete:
home business rider form.
Watercraft Please complete:
watercraft quote form.
Click here for Habitational Special Limits and additional options.
Other Comments

Coverage Options For Additional Properties
Additional Homes
Rental Property
Seasonal
Other
Is this home within 300 meters of a fire hydrant? Yes    No 
Is this home within 8 Km's of a fire hall? Yes    No 
Year built
Type and Age of Heating:
Type and Age of Electrical:
Type and Age of Roof:
Type and Age of Plumbing:
Amount of insurance required on home

All insurer's have special limits within a home policy so click Special Limits for an example of ours. Limits will vary with each insurer.
Do you have RV's, Trailers, ATVs, Sleds or other unlicensed motorized vehicles? (If yes, please describe below) Yes   No 

Last Modified: February 05 2010
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