Test Form Fields Autopop "*" indicates required fields This field is hidden when viewing the formGclidWhat would you like a quote for?* Personal insurance Business insurance Specialty programs What product(s) are you interested in?* Auto House Townhome Mobile home Condo Tenant Cottage and cabin Home being built Contents in storage Motorcycle RV Travel Marine and boat What program(s) are you interested in?* Waste Management & Recycling Oil & Gas Contractors Advensure Other Describe your business*Which of the following best describes your situation?* I own the home I rent the home I own and rent out the entire home I own and rent out a portion of the home It's vacant My rental periods are:* Short term Long term Province*Choose your provinceAlbertaBritish ColumbiaNew BrunswickNewfoundland and LabradorManitobaNova ScotiaOntarioPrince Edward IslandSaskatchewanPlease complete the questions below to help expedite your request and connect you with a Westland Advisor best suited to help you.Do you currently have Home or Business Insurance with Westland?* Yes No Do you know your policy number? (Optional)Do you currently have business insurance?* Yes No Renewal date (Optional) YYYY slash MM slash DD What industry are you in?* Business & Professional Services Cannabis Construction & Contracting Education Faith Based Organization Farm & Agriculture Forestry Healthcare Hospitality Manufacturing Not for Profit Oil & Gas Real Estate/Building Owner Recreation Retail/Wholesale Social Services Spa Transportation & Logistics Wineries Welding Other Describe your business*Your contact informationFirst name*Last name*Company*Phone*Email* Address* Street Address Address Line 2 City ZIP / Postal Code Effective date MM slash DD slash YYYY This field is hidden when viewing the formBusiness InsuranceLimit of liability required*$1,000,000$2,000,000$5,000,000Description of operations*Have you had any losses or claims in the past 5 years?* Yes No Thank you for requesting a business insurance quote from Westland Commercial. Unfortunately, based on current eligibility requirements, market conditions, and quote request volumes, we will not be able to provide a quote at this time. Please provide the following information for each loss or claim in the past 5 years:*Date of loss or damageCause or origin of loss or damageTotal amount of claim $ Add RemoveHas any insurer cancelled or declined to renew your policy or refused to provide insurance?* Yes No Thank you for requesting a business insurance quote from Westland Commercial. Unfortunately, based on current eligibility requirements, market conditions, and quote request volumes, we will not be able to provide a quote at this time. Please provide the following if you have had a policy cancelled, non-renewed or you were refused insurance.*Date of cancellation, non-renewal, or refusalReason or circumstances for the cancellation, non-renewal, or refusal: Add RemoveWhat year was your business started?*Years of related experience in this business?*What are your forecasted total annual Gross Sales this year?*$100,000 or less$100,000 - $250,000More than $250,000Do you have any sales outside Canada?* Yes No If yes, what amount*Number of employees?*Estimated payroll*Is your business operated from your Home or a Commercial premises?* Home Commercial premises Do you own or lease the building your business operates from?* Own Lease ConsentSome insurance companies offer a discount based on a personal soft credit check. This may help you achieve their most competitive price. Important note: this check will not affect your credit score and the credit score will always remain confidential. If you consent, provide the information below for the Business Owner or Majority Shareholder; I agreePlease give consent to process your quoteThank you for requesting a business insurance quote from Westland Commercial. Based on the information submitted, the estimated premium will be a minimum of $1,000, subject to receiving additional information about your business, do you want to continue?* Yes Thank you for requesting a business insurance quote from Westland Commercial. Based on the information submitted, the estimated premium will be a minimum of $750, subject to receiving additional information about your business, do you want to continue?* Yes First name*Last name*Date of birth* MM slash DD slash YYYY Home address*How long you’ve been at your home address (If less than one year, provide previous address)*Additional information (Optional)This field is hidden when viewing the formCAPTCHABy clicking request quote, you are agreeing to our privacy policy. If you are interested in learning more about how Westland protects your personal information, please visit www.westlandinsurance.ca/privacy
