Home Insurance Quote Form

Thank you for choosing our Western Financial Group licensed experts for your home insurance quote. At Western, we have access to a large number of partners and can ensure you will receive value and the right security for your insurance needs.

I wanted to follow up with you and get some information. We’ve tried to connect with you by phone and want to service your insurance request. Please either call us back or answer the following questions.

Tell us about yourself to ensure you qualify for appropriate discounts and an accurate price:

Name:
Date of Birth:
Occupation:
Phone number:
Address of the home:
Postal code:
Is this your primary residence?:
If mailing address is different please advise what it is:
Is your property a part of a Strata?:
If yes, is your property considered a “bare land condo”?:
Are you more than 13 kilometres away from a firehall?:
Are you more than 150 metres away from a fire hyrant?:
Is there a mortgage on the property?:
Are there any smokers in the home?:
What is the Length & Width of the mobile home?:
What was the purchase price of the mobile home?:
What is the make, model & serial number?:
What is the replacement cost of the mobile home?:
Is it tied down?:
Is it skirted?:
What is the foundation? ( e.g. Concrete pad, Concrete pilings, Railway Ties):
Is it CSA Approved?:
What is the CSA Number?:
Home many sections is the mobile home?:
Home many sections is the mobile home?:
What is the distance between your mobile home and the mobile home beside yours?:
Do you have a hot tub or a pool?:
Is there a home-based business operating from the home?:
Is there a fireplace or a wood stove?:
If yes, has there been WETT inspection?:

Electrical
What type of electrical wiring is it?:
What type of amp is the electrical?:
Is it on a breaker circuit?:
Has the electrical source been updated and what year was it done?:

Heating Source
What type of heat is it?:
Has the heating source been updated and what year was it done?:

Roof
What is the age of the roof?:
Type of roofing material:

Plumbing
What type of plumbing material was used?:
How old is your hot water tank?:
Has the plumbing been updated and what year was it done?:
Hot water tank - is it a storage tank or tankless?:
Do you have a sump pump?:

Misc.
Do you have a security system?:
How long have you had property insurance?:
Any gaps in insurance coverage for more than 2 years?:
Have you had any claims in the last 7 years on your home?:
Do you have a boat or travel trailer?:
Do you require coverage for things such as jewelry, bicycles, golf clubs, etc.?:
What date would you like your policy to start?:

Please indicate which Western Financial Group branch you prefer to work with?:

DID YOU KNOW?
If you bundle car and home insurance, you can earn additional discounts and savings. Would you like us to contact you about bundling your car and home insurance?:
Credit Consent
In order to provide you with the most accurate quote with the maximum savings, the insurance companies will run a soft credit check with your consent. Even if you do not provide consent, we will still provide you a quote.
Do we have your consent to access and use your credit history information as described?:
I look forward to hearing from you and delivering you the Western insurance advantage!