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Farm Care - Quick Quote Request Form

Please complete the following information and click on the "Submit Request for Quote" button, below. A quote will be prepared and returned to you via email within 24-48 hours.

Alternatively, you can print a copy of the Farm Care Quick Quote Form, fill it in and mail or fax it back to us.

Contact Intercity Insurance at 905 841 8200 or email us if you have any questions.

Applicant Information
First Name of Applicant
Last Name of Applicant
Address 1
Address 2
City
Province
Postal Code
Phone ()   -
Fax ()   -
Email Address

Property Information

Personal Possessions, Additional Living Expenses Private Structures will be quoted as a percentage of the dwelling limit shown.

Farm is Acres and is km from the nearest responding firehall,
located in the town of .
Dwelling $ Year Built
 Wood burning appliance?
Yes  No
Scheduled
Personal Items		 $ Please Describe (i.e. Jewelry, art, antiques, etc.)
Barn # 1 $ Year Built
Barn # 2 $ Year Built
Arena $ Year Built
Other outbuildings $ Year Built
  $ Year Built
Seasonal/Secondary Dwelling $ Year Built
 Occupied as (cottage, tenanted, etc)
Machinery $ Maximum value of any one item
$
Implements/Tools $ Maximum value of any one item
$
ATV $
Produce $
Horses $ Maximum value of any one horse
$
Tack & Equipment $ Maximum value of any one item
$
Other items insured $ Please define what item(s) is/are.
DEDUCTIBLE FOR LOSS $
Liability Limit $
Boarding
Yes   No 		Number of boarders
 Average value of boarded horses
$
Riding Instruction
Yes   No 		If Yes, is your Coach(es) certified? (EC, BHS, CHA, etc.)
Yes   No N/A
Other
Commercial Activities  
Claims in last 5 years?
Yes   No 		Type of Loss?
 Claim Amount
$ 		Date of Loss (YYYY MM DD)
Age of registered owner(s)
 Mortgage Free?
Yes   No 		Security System
Yes   No
Expiration of existing policy (YYYY MM DD)
 Insuring Company
Additional Comments or Questions
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