Tenant Quote Form

Name:
Address:
City:
Province:
Postal Code:
Phone number:
Email:
Years Continuously Insured:
Estimated replacement value of personal property:
Policy Deductible Preferred:	$500 $1000
Liability Amount Requested:	$1,000,000 $2,000,000
Have you had any personal property claims in the last 3 years:	YesNo