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Name:
Address:
City:
Province:
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Phone:
Email:
Age of building:
Construction of building:
Is the building sprinklered?
How much area do you occupy?
Are you the only tenant?
Is there a hydrant within 500 ft. ?(150 metres):
Is there a fire hall within 3 miles? (5 kms):
Has insurance ever been denied or canceled?
What type of business?
How many years in the business?
Have there been any insurance claims in the last 3 years?
What are the annual receipts?
What is the annual payroll?
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