Surveys - Pathway

Tell us about you:

Group Discount Rates - Select a Company

How did you hear about us?

Flyer Google Facebook Friend Other

First Name

Last Name

Address

City & Postal Code

Phone

Email

Date of Birth (mmm/dd/yyyy)

Owner Consent - Tell us if you provide consent:

Many insurance companies use personal credit information as one of the rating factors in determining discounts for property insurance. Please confirm if you are willing to give consent in order to help us provide you with the most competitive quote. Checking your credit score for insurance purposes results in a “soft inquiry” which means it has no impact on your credit score. It is not the same as reviewing the score for a loan or credit card which may lower the score.

Do we have your consent to run a "soft inquiry"?

Yes No

It's important that your address & phone number is accurate in obtaining a "soft inquiry"

What is the age of your dwelling? (0-99)

Tell us about your insurance history:

How long has your property been continuously insured?

How long have you been with current insurance company?

Current Property Insurance Expiry Date (mm/dd/yyyy)

Have you been cancelled or refused by an insurer in the last 3 years?

Yes No

Any claims in last 5 years?

Yes No

If yes, please select how many

Smoke-Free Household?

Yes No

Sump Pump

Yes No

If you answered Yes to Sump Pump

Backflow Valve Battery Backup Sump Pump Alarm None

Basement finished?

Yes No

Do you have a mortgage?

Yes No

Do you run a Business from your home?

Yes No

Do you rent any portion of your home?

Yes No

How would you like us to contact you?

Email Phone

Do you own a car?

Yes no

Notes / Best time to call

Request a Home Quote