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