Victoria Office
Phone: (250) 388-5555

Westshore Office
Phone: (250) 478-5588

Duncan Office
Phone: (250) 856-9440

Liquor Quote

General Information

Business Name:


Contact Name:
eg: John Smith


Address:


City:


Province:


Postal Code:


Phone Number:


Email Address:


Which Office would you like to deal with?:




Type of Operation (check all that apply)

Neighbourhood Pub
Bar or nightclub with entertainment
Bar with exotic dancer
Food service provided
Liquor store or beer and wine store attached
Other (describe in detail below)


Annual Sales Information


Liquor on Premises


Liquor, Beer & Wine Outlet


Food Sales


Automated Teller Machines


Video Lottery Terminals


Other


Coverage Information


Liability Limit
Building Limit


Crime (Money & Security)
Boiler and Machinery


Glass: YesNo
Forcible Ejection: YesNo


Previous Coverage Information


Existing Liquor Liability Insurance Company:


Existing Insurance Broker:


Premium:
Limits:


Policy Number:
Effective Dates:


Other Information

Previous Claims or Losses in the past 5 years
(please include approximate date, details and claim payout amount)


Additional Comment
Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough space, please enter them here.