Online homeowners QUOTE Request

 

Simply fill out the appropriate fields below, click submit, and a Miller Insurance Broker will be happy to provide you with a quote.

 

PERSONAL INFORMATION

 

First Name                 Home Phone # 

Last Name                 Work Phone # 

Address                     E-mail address:

City             

Province     

Postal Code

 

How do you prefer to be contacted?  

 

Do you presently have any type of insurance with Miller Insurance Brokers?

Are you employed by Bruce Power or South Bruce Grey Health Centre?

 

Dwelling Information

 

Type of Dwelling:

Year Built:

# of Storeys:

Ground Floor Square Footage:

Basement:         % of Basement Finished 

Fire Protection:  Fire Hydrant within 300m

Distance from Firehall km's

Exterior Building Material:

Attached Garage? 

Deck:           If Yes ft2

Heating:

Any Auxiliary Heating?

Electric Service:  100 amp   200 amp   Breaker Panel  Fuses

Plumbing:  Copper & Plastic    Galvanised (Lead)

Roof:               Last Update 

 

 

  

Insurance Details

 

Current Insurance Company:

Policy Expiry Date:

 

Any claims in the past 5 years?  (If yes, give date and description of any claims)

 

 

 

Current Type of Coverage:     Comprehensive        Broadform   Named Perils

Current Amount of Coverage on Dwelling:

# of mortgages on your property:

Have you been cancelled by an insurance company in the last 5 years for non-payment?

 

I also need coverage for:

 

Boat

Seasonal Dwelling or Trailer

Rental Property

Home Based Business

Jewellery

 

 Which office do you wish to deal with for your insurance needs?

 

 

By checking this box, I indicate that I have read, understood and AGREE to the terms of Miller Insurance Brokers’ Privacy Statement.

 

DISCLAIMER: By submitting this request for quotation, it is hereby understood that this is not a Policy of Insurance, Insurance Application or Offer by Miller Insurance Brokers Inc. to insure on behalf of any company.  We reserve the right to accept or deny any and all request, upon examination and analysis.