| Bakes-Jarvie Insurance |
CONDO QUOTE APPLICATION FORM-- |
Completion of this form is for informational purposes only
ONLY AVAILABLE IN BC, CANADA |
| APPLICANT INFO: |
| Name of Insured: |
Email Address: |
| Phone #: |
Phone 2: |
| Address: City: Postal Code: |
| Preferred Contact Method: |
| Are you over 50 years old? |
Do you currently have insurance? |
| BUILDING INFO: |
| Building Type: |
| Contents Limit you need Insured: |
Number of claims in the last 5 years: |
| Do you want Earthquake Coverage? No Yes |
| Monitored Burglar Alarm? No Yes |
| Sprinklered? No Yes |
| SCHEDULED ITEMS DESIRED: |
| Jewelry |
Yes No |
Value: |
| Sports Equipment |
Yes No |
Value: |
| Cameras |
Yes No |
Value: |
| Other |
|
Value: |
| Comments: |
|
| |
