Blair Insurance Brokers


	Fast Quote: (905) 472-0774 176 Bullock Drive, Unit #1 Markham, Ontario L3P 1W2

COMMERCIAL INSURANCE QUOTE

Name:
Email:
Address:
City:
Postal Code:
Phone:
Fax:
Current policy expiry date:
Describe your business (all of your operations):
How many years in business?:
Have there been any insurance claims in the last 3 years?:
What are the annual receipts?:
Age of building:
Construction of building:
Is the building sprinklered?
How much area do you occupy?
Tenant or own?:
Is there a hydrant within 150 metres?:	Yes No
Is there a fire hall within 5 kms? :	Yes No
Has insurance ever been denied or cancelled?:	Yes No
Additional comments: