Shop Insurance Application Submission of this information does not represent a binding of any insurance contract or agreement. Additional information may be required in order to get an accurate quote of insurance Name First Last Business NameEmail PhoneAddress Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code What Does Your Business Sell?Gross Sales Per Year:Any Sales from Outside of Canada? Yes No Sales from Outside of Canada, Please List which Countries and What Percentage of Sales Come from That CountryDo Any Of Your Products Come From Suppliers Outside of Canada? Yes No Which Country Do Your Products Come From and Which ProductsHow Many Employees Do You Have?CoveragesValue of StockValue of EquipmentLimit of Liability Insurance: $2 Million $5 Million More Consent* I agree to the Privacy Policy and acknowledge the Disclosure Statement.
