QUOTE ME . . . .

Please complete the form bellow as fully as possible and we will be back to you as soon as possible with prices and cover details.

If you have any problems or need a quote urgently contact our motor industry specialists on:

Name:

Address Inc Postcode:

Landline Phone Number:

Mobile Phone Number:

Premises Type:

Premises Construction:

Nature Of Business:

Full Time or Part Time:

Number of years trading:

Type of vehicles worked with:

Cover Required:

Indemnity Level:

No Claims Discount:

No claims discount Type:

Driver 1

Name

Age

Use

Driver 2

Name

Age

Use

Driver 3

Name

Age

Use

Driver 4

Name

Age

Use

Details of ALL drivers convictions in the last FIVE years or TEN years in the case of drink drive offences (Include code, date, fine & points)

Details of ALL drivers accidents or claims in last 3 years

PLEASE ONLY COMPLETE NEXT SECTION IF YOU REQUIRE A FULL COMBINED MOTOR TRADE QUOTATION

Where are vehicles kept overnight?

Fire Extinguishers?:

Premises Alarmed?

PROPERTY DAMAGE COVER

Buildings Sum Insured (£)

Stock Of Parts Etc (£)

Stock Of Tyres (£)

Own Vehicles at premises (£)

Customers Vehicles at Premises (£)

Tools - inc cabinets (£)

Computers (£)

Machinery & all other contents (£)

CASH COVER

Amount Required (£)

BUSINESS INTERRUPTION COVER

Gross Profit Sum Insured (£)

Period Of Cover

LIABILITY COVER

Public Liability Sum Insured

Turn Over Per Year (£)

Employers Liability -

Wage Roll Total Per Year (£)

Number of employees:

Current Insurers:

Renewal Date:

Any Other Information

Thanks for taking the time to complete this form - we know its a bit of a pain - but it is worth it!

Finally.....

Would you like any of our trading partners to contact you regarding any of the following?:

Contract Hire
Yes No

Vehicle Tracking Systems?
Yes No

Vehicle Hire?
Yes No

Accountancy & Auditing?
Yes No

Pension Advice?
Yes No

Motor Conviction Solicitors
Yes No

Contact our motor industry specialists on: 0844 873 3925

Or fax your details and current insurance schedule to: 0844 873 39256

Our team is run by Tony Rollins AMIMI who previously ran a vehicle
repair centre and is still and associate of the institute of the motor industry.
Tony won the British Insurance Broker Association Young
Broker of the year for the Northern Region in for 2006 and has been
in the insurance industry for over 12 years.

We understand your business -maybe not as well as you!
but enough to ensure you get the right cover at the right price.

Courier Insurance? Click here..

Have you had an accident thats not your fault?

Then we can help!

Visit:

injurypanelassociates.co.uk

Facing a motoring conviction or
even a ban?

Kaufman Legal can help!

Kaufman Legal are specialist law advisorsand can advise on all motoring offences from speeding
to drink driving.

Don't risk your license -
speak to Kaufman Legal on
0800 88 18 21
or visit...
www.kaufmanlegal.co.uk