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Contact Us:

P: (403) 508-1111 F: (403) 508-1118
holly-gordon
@shaw.ca

# 102
1010 8th Ave SW
Calgary, AB
T2P 1J2

Free Online Home Insurance Quote

Welcome to our online Habitat Quote system.

To get a no obligation quote, please complete the following form and submit it to our office.
You will be contacted via your chosen method(below), within the next three business days.

Please note:
All fields must be completed for us to give you an accurate quote.

Personal Information


First Name:	Last Name:

Age:
Address:
City:
Province:	Postal Code:
Current Employer:

Contact Information


Home Phone:
Office Phone:	Ext.
Fax:
E-mail:
Contact By:	E-mail Phone Mail

Insurance Information


Have you ever had your insurance cancelled or refused?
	Yes No
Do you currently have insurance?
	Yes No
If so, how long have you been insured?

When would you want the coverage to start? (dd/mm/yyyy)

Property Information

	Location 1	Location 2
Is it a:
Is this your:
Do you:
What year was it built?
If it is over 20 years old, have any of these been updated or replaced:	Furnace	Furnace
	Roof	Roof
	Wiring	Wiring
	Plumbing	Plumbing
Is there an alarm system:
If yes, is it:
Is your property Located within:

Coverages & Deductions


Building Amount: ($)
Contents Amount: ($)
Liability Amount:
Deductible:
If you have any extra coverages, such as special coverage for expensive jewellery, boats, furs, etc., please make a note of it in the comments section below.

Claims Information

		Date of Claim
	Type of Claim:	(mm/yyyy)	Location Involved:
1.
2.
3.

Comments

Comment
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