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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?:
Yes
No
If mailing address is different please advise what it is:
Is your property a part of a Strata?:
Yes
No
If yes, is your property considered a “bare land condo”?:
Yes
No
Are you more than 13 kilometres away from a firehall?:
Yes
No
Are you more than 150 metres away from a fire hyrant?:
Yes
No
Is there a mortgage on the property?:
Yes
No
Are there any smokers in the home?:
Yes
No
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?:
Yes
No
What is the CSA Number?:
Home many sections is the mobile home?:
Single wide
Double wide
Home many sections is the mobile home?:
Single wide
What is the distance between your mobile home and the mobile home beside yours?:
Do you have a hot tub or a pool?:
Yes
No
Is there a home-based business operating from the home?:
Yes
No
Is there a fireplace or a wood stove?:
Yes
No
If yes, has there been WETT inspection?:
Yes
No
Electrical
What type of electrical wiring is it?:
Copper
Aluminum
What type of amp is the electrical?:
60 amp
100 amp
200 amp
Is it on a breaker circuit?:
Yes
No
Has the electrical source been updated and what year was it done?:
Heating Source
What type of heat is it?:
Central Furnace - Gas
Has the heating source been updated and what year was it done?:
Roof
What is the age of the roof?:
Type of roofing material:
Asphalt shingles
Plumbing
What type of plumbing material was used?:
Copper
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?:
Yes
No
Misc.
Do you have a security system?:
Yes
No
How long have you had property insurance?:
Any gaps in insurance coverage for more than 2 years?:
Yes
No
Have you had any claims in the last 7 years on your home?:
Yes
No
Do you have a boat or travel trailer?:
Yes
No
Do you require coverage for things such as jewelry, bicycles, golf clubs, etc.?:
Yes
No
What date would you like your policy to start?:
Please indicate which Western Financial Group branch you prefer to work with?:
100 Mile House

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?:
Yes
No

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 consent
I do not consent
I look forward to hearing from you and delivering you the Western insurance advantage!