Condominium and Tenant Insurance Online Quote CONTACT INFORMATION Surname: * First Name: Address: Age of oldest insured: Telephone: E-mail: * City: Province: * Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Postal Code: Employer/Association: RATING INFORMATION Occupancy: Condo Owner    Tenant Structure Type: Highrise Less than 6 Units Over 6 Units Construction: Masonry Brick Veneer Frame Other Primary Heat: Electric Gas Oil Woodstove Auxilary Heat: Fire Protection Fire Hydrant Fire Hall Unprotected Alarm Are you Smokers? Yes  No INSURANCE Any prior insurance coverage? Yes  No Any claims in the past? Yes  No            If yes, explain: Do you require additional coverage i.e. valuables/watercraft? Yes  No            If yes, explain: What is the replacement value of your contents? Renewal Date: (mm-dd-yyyy) Please tell us how you found our site: Fairlie Insurance Agency CAUT A search engine Referred by a friend Other

INSTAR Insurance Brokers Inc.
2435 Holly Lane, Suite 200
Ottawa, Ontario K1V 7P2

Toll Free: 1-888-769-9299
Local: (613) 228-1600
Fax: (613) 232-6486
info@instar.on.ca