Call Now:
0121 4531945
HOME
SERVICES
QUOTATION FORM
ABOUT US/CONTACT US
FAQ'S
TERMS OF BUSINESS
Thank you for submitting your qoutation, your qoutation form has been sent and we will contact you within 24 hours.
Quotation Road Risks
About You (The Proposer)
Full Name
*
Age
*
Email
*
Business Address
*
Post Code
*
Telephone No.
*
Daytime
Mobile No
*
Preferred Contact Method
*
Please Select
Telephone
Email
Post
About Your Business
Working from
Please Select
Home
Workshop
Forecourt
Mobile
Your Status
Please Select
Sale Trader
Partnership
Limited Company
If you work from premises please check this box if you require cover for vehicles at premises
Premises Post Code
(if cover required away from home)
Full Time Motor Trade
Part Time Motor Trade
*
*
If Part Time please give other occupation
If Part Time, are you self employed?
Please Select
No
Yes
If Part Time, do you require additional cover for this occupation
Please Select
No
Yes
Number of years established?
Name
Age
Date of Birth
Motor Trade Status
Other Occupation
Use
1
Proposer
Please Select
Proprietor
Business Partner
Employee
Spouse
Please Select
Motor Trade & Private
Motor Trade
Private
2
Please Select
Proprietor
Business Partner
Employee
Spouse
Please Select
Motor Trade & Private
Motor Trade
Private
3
Please Select
Proprietor
Business Partner
Employee
Spouse
Please Select
Motor Trade & Private
Motor Trade
Private
4
Please Select
Proprietor
Business Partner
Employee
Spouse
Please Select
Motor Trade & Private
Motor Trade
Private
5
Please Select
Proprietor
Business Partner
Employee
Spouse
Please Select
Motor Trade & Private
Motor Trade
Private
Driver no
Years Licence Held
Accidents/Claims
(last 3 years)
Motoring Convictions
(Last 5 years)
Banned?
Health Conditions
1
2
3
4
5
If you have answered yes to any accidents/claims/convictions/disqualifications or health conditions please give details below:
1
2
3
4
5
6
7
8
9
10
About Your Motor Trade Activities
Are You Involved With?
(Motor trade activities must add up to 100%)
Sales of Vehicles
%
Sales of Parts or Accessories
%
Import and/or Export
%
Mechanical Repairs/Service
%
Tyre Sales/Exhaust Fitting
%
Scrap or Salvage
%
Vehicle Recovery/Breakdown
%
Body Repairs
%
Valeting
%
Other
%
Sports or High Performance
%
Classic
%
Motorcycles
%
Coaches or Buses
%
Modified or Kit Cars
%
Commercial Vehicles over 3.5t
%
American or Canadian
%
Japanese Imports
%
Vehicles with more than 8 seats
%
Other
%
Cover
Type of Cover Required
Please Select
Comprehensive
Third Party Fire Theft
Third Party Only
Voluntary Excess
Please Select
£0
£250
£500
Maximum Value any one vehicles
Please Select
£2500
£5000
£7500
£10000
£12500
£15000
£20000
£25000
£30000
Total Value of all vehicles
Would you like to include accompanied Demonstration Cover?
Please Select
Yes
No
No Claims Bonus
Are you entitled to any No Claims Bonus?
Yes
NO
If Yes, please advise which type of No Claims Bonus
Please Select
Private Car
Motor Trade
Commercial Vahicle
Number of Years earned
Please Select
0
1
2
3
4
5
5+
When does your current policy expire?
} ?>
Motor Trade Insurance Specialists
Authorised and Regulated by the Financial Services Authority (FSA) Registration Number 304327
HOME
|
SERVICES
|
QUOTATION FORM
|
ABOUT US/CONTACT US
|
FAQ’S
|
TERMS OF BUSINESS
© Copyrights 2004-2007 Motor Trade Insurance All Rights Reserved. A Project of
e-commerce123.com