Property Application Form

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Grey Power Property Insurance Application Form

Please complete this Property Insurance Application Form. It will be emailed directly to our office. We'll review it, and get right back to you to discuss your responses with you.

Please provide the following contact information:

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
E-mail

Type of Dwelling:

Do you rent or own:

Rent Own

If you rent, please complete the following:
Current contents coverage:

......then click here to link to the Submit Button.

If you own your property, please complete the following:

Square footage of home:

Number of story's:

Year built:

Brick or siding:

Brick Siding

Number of full, four-piece bathrooms:

Square footage of finished basement:

Do you have porches or decks:

Porch Deck

Do you have a fireplace:

None Gas Wood

Do you have a woodstove:

Select the option that best describes your garage:

Do you have a swimming pool:

Do you have Central Vacuum:

Do you have a Garage Door opener:

Do you have a Jetted or Jacuzzi tub:

Type of heating (select all that apply):

Natural Gas Electric Baseboard Electric Furnace Propane
Coal Wood

Security System:

Electrical System:

Plumbing System:

Year roof last updated:

Location of fire protection:

within 1000 feet of a fire hydrant
within 5 miles of a firehall
other

Describe all claims you have had in the past five years from any property insurance policy:

Is there a business operated out of your home:

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