Home Insurance Quote Sheet
 
Instructions: Please fill in the following information and a Qualified Johnston Meier Insurance Representative will contact you with your quote. 

Note: Quoted prices are only valid within the Province of British Columbia, Canada.

1.
Building Limit
2.Deductible required
3.Limit of liability coverage required
4.Type of Structure
5.Construction of building
6.Year building constructed
7.Is there rental of any portion of the home
8.Type of heating
9.Wood Heat
10.Fire Protection
11.Mature Age Discount Applies
If Yes, please provide Date of Birth:
12.Alarm System
If yes, 
13.Mortgage Free Discount Applies
14..Years Continuously Insured Claimsfree
15.Additional coverages requiredYes No 
     If yes, please give details:

16.Have you had any losses in the
last 3 years?
     If so, give details & claims amount
     paid by the insurance company:
.
.
Additional information may be required in order to
verify rating. One of our qualified representatives will
contact you to confirm the information provided.
.
Contact Information
Name
Address
City
Postal Code
Email Address
Telephone #
Fax #