114 Main Street, Box 160, Rockyford, AB · Ph: 403.533.3771 · Toll Free: 877.533.3771

2, 216 4 Avenue, Box 2132, Strathmore, AB · Ph: 403.934.3770 · Toll Free: 877.464.1860

Hillcrest Insurance | Get a Quote

Please fill out the following information

Customer Information:

Preferred method of contact:

Insurance Information:

Year Building Was Built:
Square Footage: Total of All Levels Excluding Basement:
House Style:
Attached Garage:
Number of Car Garage:
Outside wall cover:
Fireplace/Alternate Heat:
Deck Size:
% of Basement Complete:
Other distinguishing features (granite countertops or high-end fixtures):
Do you have existing insurance?:
How many claims in the past 5 Years?:
If in a rural Location how far is the nearest firehall?:
Do you rent a room or suite?:
Do you have a security system?:
Is it monitored?:
Do you have a monitored Fire Alarm?:
Date of Birth:

If your home is over 15 years old, please indicate the year that upgrading was done on the following:

Roof:(Age of shingles)
Heating system:(Age of furnace)
Wiring:(Age of panel box)
Plumbing:(when were last updates done)
Do you have a home based business?:
Do you have any other property or special items that require insurance coverage?:
Word Verification: