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First Name
*
Last Name
*
Email
*
Phone
*
Address
*
City
*
Province
*
Postal Code
*
Drivers Licence Number
*
Licence Plate Number
*
I consent that Butler Byers can review my vehicle information to determine the best package policy coverage
*
Yes
First Name
*
Last Name
*
Email
*
Phone
*
Date of Birth
*
Address
*
City
*
Province
*
Postal Code
*
Year your home was built
*
Square footage
*
Building type
*
Detached
Duplex
Semi Detached
Roof type
*
Asphalt Shingles
Wood Shingles
Clay Shingles
Steel
Rubber
Foundation Type
*
Basement
Slab
Walkout
Crawlspace
Is the basement finished?
*
Yes
No
Exterior Walls
*
Stucco
Vinyl
Brick
Brick veneer
Concrete
Log
Stone
Stone veneer
Number of stories
*
1
1.5
2
2.5
Bilevel
Trilevel
Number of bathrooms
*
1
1.5
2
2.5
3
3.5
4
Number of kitchens
*
1
2
3
Attached structures
*
1 car garage
2 car garage
3 car garage
none
Swimming pool
*
Yes
No
First Name
*
Last Name
*
Email
*
Phone
*
Date of Birth
*
Address
*
City
*
Province
*
Postal Code
*
Contents Amount
*
Year Built
*
First Name
*
Last Name
*
Email
*
Phone
*
Date of Birth
*
Address
*
City
*
Province
*
Postal Code
*
Contents Amount
*
First Name
*
Last Name
*
Email
*
Phone
*
Date of Birth
*
Address
*
City
*
Province
*
Postal Code
*
Year your home was built
*
Square footage
*
Building type
*
Detached
Duplex
Semi Detached
Roof type
*
Asphalt Shingles
Wood Shingles
Clay Shingles
Steel
Rubber
Foundation Type
*
Basement
Slab
Walkout
Crawlspace
Is the basement finished?
*
Yes
No
Exterior Walls
*
Stucco
Vinyl
Brick
Brick veneer
Concrete
Log
Stone
Stone veneer
Number of stories
*
1
1.5
2
2.5
Bilevel
Trilevel
Number of bathrooms
*
1
1.5
2
2.5
3
3.5
4
Number of kitchens
*
1
2
3
Attached structures
*
1 car garage
2 car garage
3 car garage
none
Swimming pool
*
Yes
No
First Name
*
Last Name
*
Email
*
Phone
*
Date of Birth
*
Date of Departure
*
Date of Return
*
Are you a resident of Saskatchewan
*
Yes
No
Do you have a Saskatchewan health card
*
Yes
No
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(306)653-2233