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First Name*

Last Name*

Email*

Phone*

Birthday

How many years have you had continuous property insurance?*

Have you had a claim in the last 5 years?*

Coverage start date?*

Address to Insure*

Postal Code*

Ownership Type*

If living, when was the move in year?*

If renting, what was the year purchased?*

Type of Condo*

Year Built?

Primary Exterior Finish*

Number of stories?*

Square Footage*

What % of the basement is finished?*

Number of Bathrooms

Roof Type?*

Primary Heating Source

Age of Primary Heating*

Do you have a mortgage?

Any smokers in the household?

USEFUL LINKS

Auto Insurance

Home & Property Insurance

LONDON OFFICE

(519) 601-1100

info@caneinsurance.com

829 Richmond St,

London, ON

N6A 3H7

WATERLOO OFFICE

(519) 570-1117

info.kw@caneinsurance.com

105-375 University Ave E

Waterloo, ON

N2K 3M7

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