 |
|
| Select a Company: |
|
| Name: |
|
| Address: |
|
| City: |
|
| Province: |
|
| Postal Code: |
(X1Y 2Z3) |
| Phone Number: |
(123-456-7890) |
| Fax Number: |
(123-456-7890) |
| Email Address: |
(xxx@yyyy.zzz) |
| Age of building: |
|
| Construction of building: |
|
| Is the building sprinklered? |
|
| How much area do you occupy? |
|
| Are you the only tenant? |
|
| Is there a hydrant within 500 ft. (150 metres)? |
|
| Is there a fire hall within 3 miles (5 kms)? |
|
| Has insurance ever been denied or canceled? |
|
| What type of business? |
|
| How many years in the business? |
|
Have there been any insurance
claims in the last 3 years? |
|
| What are the annual receipts? |
|
| What is the annual payroll? |
|
| |
|
| |
Disclaimer |
