Thank you for your interest in Maple Insurance. Please complete the form below to request a quote for insurance:
*Required fields
First Name *
Last Name *
Email Address *
Phone *
Address *
City *
Province *
Postal Code *
Date of Birth: Select date... *
When should your new coverage start? Select date... *
What is your occupation?
How did you hear about us?
How would you like to be contacted? Phone Email *
Have you ever had an insurance cancelled or refused? Yes No *
Do you currently insure your property? Yes No *
Number of years with prior property or home insurance: *
How many insurance claims have you made in the past 10 years? Please select... None 1 2 3 4 5 Over 5 *
Property Type: Please select... 2 Story House Bungalow Town House Condominium Seasonal Resident Building *
Own / Rent: Please Select... Own Rent *
Use Please select... Primary Home Cottage (year round) Cottage (Summer) Rental Property Other *
Year Built: *
If property is over 30 years old, which of the following have been replaced? Furnace Wiring Roof Plumbing
Is property equipped with a monitored alarm? Yes No *
Are you within 300 m of a hydrant? Yes No *
How long have you had continuous insurance coverage? Please select... 0 years 1 year 2 years 3 years 4 years 5 to 10 years Over 10 years Over 20 years *
Coverage amount required for building (home)? *
Coverage amount required for your content? *
Liability Please select... $1,000,000 $2,000,000 $5,000,000 *
Deductible: Please select... $300 $500 $1000 *
Property Type: Please select... 2 Story House Bungalow Town House Condominium Seasonal Resident Building
Own / Rent: Please Select... Own Rent
Year Built:
If property is over 30 years old, which of the following have been replaced? Furnace Roof Plumbing
Are you within 300 m of a hydrant? Yes No
How long have you had continuous insurance coverage? Please select... 0 years 1 year 2 years 3 years 4 years 5 to 10 years Over 10 years Over 20 years
Coverage amount required for building (home)?
Coverage amount required for your content?
Liability Please select... $1,000,000 $2,000,000 $5,000,000
Deductible: Please select... $300 $500 $1000
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