Mayfair Online - Insurance Consultants

Household Insurance Direct: Quotation form
In order for us to process this form successfully, please fill in exact details. Also include a valid email address.
Full Name:	D.O.B.:
Address:	Town/City:
County:	Postcode:
Daytime Phone:	Work Phone:
Mobile Number:	E-Mail Address:
Occupation:

IF YOU ONLY NEED INFORMATION about this type of insurance and don't want to fill out this entire form please fill out the next box and tell us what information you require. Then click on 'GO' button, which will take you to the bottom of the page. You should then click the 'SUBMIT' button which will send us your details. (If this does not apply, please carry on with your details.)
Information required:	Click on submit at base of page.

Property Details:

Property Type: Other, Please state:
Age of Property:	Number of Bedrooms:
Construction Type:	Are you the:

Is the property to be insured your permanent address:		Yes No
Will it solely be occupied by you, your partner and members of your family:		Yes No

Cover Required:

Buildings Standard Cover:
Buildings Standard Cover & Accidental Cover:
Buildings Sum Insure:
Contents Standard Cover:
Contents Standard Cover & Accidental Cover:
Contents Sum Insured:

Insurance History:

Number of years house insurance held:
Number of years claim free on buildings:
Number of years claim free on contents:
Have you had any claims in the last 5 years:	Yes No


Copyright © 2002 Mayfair Insurance & Mortgage Consultants Ltd. Reg. 2275219 An independent intermediary for a number of insurers.