Truck Insurance Form
Your Details
Full name / Company name:
*
Contact telephone number:
*
Email address:
*
Describe your current business activities:
*
Business address:
*
Postcode:
*
Vehicle Details
Full description of machines to be covered, including trailers (Year/Make/Model/Carrying Capacity):
*
Current Market Value:
*
Finance Type:
*
Please select
Fully owned
Hire purchase
Lease
Bank Loan
Unsecured Loan
Drivers year of birth:
*
Radius of operation:
*
Please select
Up to 250km
Up to 400km
Up to 600km
Up to 1000km
Up to 1500km
Australia wide
No Claims Bonus:
*
Do you require Public Liability Insurance for your business:
*
Yes
No
Do you require cover for your load or carriers liability:
*
Yes
No
Please provide full details of any claims made and/or losses suffered under a similar Truck Insurance policy during the past 5 years (whether or not a claim was made):
*
If none, please state
Please use this box to provide any further information that may be relevant to your Truck Insurance policy:
Current Truck Insurance provider:
*
If none, please state
Current Truck Insurance premium:
*
If none, please state
Renewal date of existing insurance / date cover to start (as applicable):
*
NB: Cover is not in force until agreed upon by the company
Contacting You
Are you an existing Trades Essentials customer?
*
yes
no
Preferred contact method:
*
Please select
Telephone
Email
Letter
Preferred contact time:
Please select
No preference
08:00-10:00
10:00-12:00
12:00-14:00
14:00-16:00
16:00-18:00
How did you hear about us?
*
Please select
Google search
Referred by friend
Referred by another business
Referred by another website
Search engine
Advertising
Trades Essentials is a trading name of Bourchier Nominees Pty Ltd. We would like to contact you from time to time about products and services (or with news, offers, and promotions) that we feel may be of interest to you. By providing us with your contact details, you consent to being contacted by these methods for these purposes.
Please tick the box if you prefer to
not
receive marketing communications from us by post or telephone.
Please tick the box if you prefer to
not
receive marketing communications from us by email, text messaging or other electronic means.