*indicates required field Name * Email * Mailing Address Location Address (if different) Phone * Fax Type of Business Years in Business Previous Insurance Company Expiry Date Building (General) Number of Storeys Number of Units Year Constructed     Construction / Condition of Building Walls Roof Electric (fuses or circuit breakers) Heating Air conditioning Sprinklers Entire building Roof Underground Parking Number of fire extinguishers Alarms/Security Burglar Fire De-Vac Line/or monitored Name of monitoring company: Camera Surveillance Windows Barred Guard Dog Other Footage/Occupancy Square footage occupied ft Total square footage of building ft Occupancy Other Occupants Amount of Insurance Building $ Equipment $ Stock $ Liability $ Comments   ©2006 John Ross Insurance Website design in Vancouver by Graphically Speaking