AmityFin || We keep our promises

Business Name*

Owner's Name*

Street Address*

City*

State / Province*

Postal / Zip Code*

Phone Number *

Fax Number*

Email Address*

Age of Building*

Description of Operations*

Is the premises sprinklered?
Yes No

Square footage you occupy*

Construction of building*

What type of business is to your left? *

What type of business is to your right?*

Hydrant with 300 metres?
Yes No

Firehall within 5 kms?
Yes No

Monitored Alarm on premises?
Yes No

Interior motion detectors?
Yes No

How many years in business?*

Do you currently have insurance?
Yes No

Insurance company*

Policy Number*

Expiry Date*

Has there been any claims in the last 5 years?
Yes No

Date of last claim*

Annual gross sales receipts*

Annual Payroll*