Contact Information

Full Name

Address

Postal-Code

City

If you have lived at your address for less than 3 years, please provide your previous address:

Phone Number

Email Address

Occupation / Employer

I agree to receive correspondence from Alpine Insurance & Financial in accordance with Canada's Anti-Spam Legislation

Are you an existing client?

Yes

No

Next Steps...

To provide the most accurate quote possible we need to gather some more details from you. You can choose to have a representative contact you to go over the quote on the phone, or fill out the online form in full. Please select your preferred option:

I would like to complete the form online.

I would like to have a representative contact me.

Step 2: Applicant(s) Information

Please fill out as much information as possible. If you do not complete all of the fields, a representative may need to contact you in order to collect the missing information. If you are unsure please make your best guess or contact the landlord.

Gender

Male

Female

Date of Birth

Have you ever had property insurance before?

Yes

No

When do you need insurance to start?

Step 3: Coverage

Please fill out as much information as possible.

Is the property within 300m of a fire hydrant & within 8kms of a fire hall.

Yes

No

unsure

Are there any smokers in the household?

Yes

No

How much content/personal property coverage do you need? $50,000 is minimum

Last Step: Dwelling Information

Please answer these last few questions and we'll get to work on your quote!

What is the square footage (estimate)?

Type of Dwelling

What is the building made of?

How many bedrooms?

How many bathrooms?

What year was it built?

When did/do you move in?

How many people live there?

What is their relationship to you?

Do you have any claims in the last 10 years?

Yes

No

Do you have any high-value items (jewellery, collectibles, bikes, etc...)

Do you operate any kind of home-based business?

Yes

No

If you have lived at your current address for less than 3 years, please provide the addresses of your previous residences:

Do you consent to a soft credit check?

Some of our insurance companies require a soft credit check to qualify you for certain discounts. The soft check will not affect your credit score.

Additional Comments

Do you have any other types of insurance you would like to get a quote for?

List any additional types of insurance you would like a quote for, ie: Car, RV, Motorcyle...

Tenant Insurance Quote

Contact Information

Next Steps...

Step 2: Applicant(s) Information

Step 3: Coverage

Last Step: Dwelling Information

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