Any quotation for Auto Insurance is based on the information you provide with your Request for Quotation (RFQ) below. Should you accept a quotation, the information you provide in your RFQ will be verified. In the event that the information is incomplete or inaccurate, the Insurer reserves the right to revise the premium accordingly or withdraw coverage, if coverage has been bound. If the Insurer is required to withdraw coverage under these circumstances, you may encounter difficulty in obtaining coverage in the future. Prior to binding coverage, you may be requested to provide the following documentation: Current Driver Abstract – 3 Year Statement of Driving Record for each driver. Driver Abstracts are available from a Ministry of Transportation - Driver and Vehicle Licensing Office or ServiceOntario Kiosk near you or online at www.mto.gov.on.ca for a nominal cost. Loss experience letter(s) from the prior insurer(s) covering the past 6 years, with no coverage breaks. Client Consent Form (available from our office) authorizing Waddell Insurance to act as your exclusive Broker and to release personal information for the purpose of securing requested insurance products and services. Please proceed to input your Request For Quotation. * = Required field Name: Email Address: Address: City: Province: Postal Code: Phone Number: Age of Building: < 1 year 1 - 20 years 20 - 35 years > 35 years Construction of building: Frame Masonry Non-Combustible Fire Resistive Is the building sprinklered: YesNo How much area do you occupy: < 5,000 5,000 - 10,000 > 10,000 Are you the only tenant: YesNo Is there a hydrant within 500 ft. (150 metres): YesNo Is there a fire hall within 3 miles (5 kms): YesNo Has insurance ever been denied or canceled: YesNo What type of business: Retail Office Building Ownership Wholesale Operation Farm Service Operation Contractor Garage Operation Manufacturer Other How many years in the business: < 1 years 1 - 5 years > 5 years Have there been any insurance claims in the last 3 years: No <= 2 >= 3 What are the annual receipts: Up to $50,000 $51,000 to $100,000 $101,000 to $500,000 $501,000 to $1,000,000 Over $1,000,000 What is the annual payroll: Up to $50,000 $51,000 to $100,000 $101,000 to $500,000 $501,000 to $1,000,000 Over $1,000,000 Security code: Enter security code: