First Name
Last Name
Date of Birth YYYY-MM-DD
Unit number (if applicable)
Street
City
Province Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nunavut Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon
Postal Code
Homeowner Property Type HouseCondo
Ownership Type I own the home, and occupy the home I'm a tenant I own the home, don't live in it and rent it to someone else
Phone
Email
How do you prefer to be contacted? PhoneEmail
Who will be living here? Just me Me and my family Me and others paying rent Me, my family, and others paying rent My family members not paying rent
Do you currently have insurance? YesNo
How many years have you had insurance?
When did you move to this location?
Are you a current client of CapriCMW? YesNo
Is there a sprinkler system in the unit? YesNo
Does the unit have an alarm system for burglary? YesNo
How much contents coverage would you like? This is the cost to replace all of your belongings in the event of a total loss.
Comments