Mayfair Online - Insurance Consultants

26 Oct 09

Italian Car Showday
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Contact Information

How did you hear about us

Proposer Name:

D/O/B:

Home Post Code:

1st line of that address:

Daytime Telephone Number:

Evening Telephone Number:

Email Address:

Business Info

Company Name:

Trading Post Code:

Trading Address Line 1:

Company Web Address:

Company Industry:

Years trading:

Fleet Vehicle Use:

Fleet Facts

If you have a vehicle schedule please email to fleet@mayfaironline.co.uk
and complete the online quote.

How many vehicles will be covered under the fleet policy ?

Vehicle Type:

Make:

Model:

Engine CC/GVW:

Year of Make:

Value:

Fuel Type:

Cover Required:

Security & Hirer Information

Security

Overnight parking Post code:

Overnight parking:

Overnight parking premises:

Alarms & Immobilisers Fitted:

Number of tracking devices fitted:

The Drivers

Minimum Driver Age:

Maximum Driver Age:

Max Convictions (within 5yrs) for Drivers:

Max Claims (within 5yrs) for Drivers:

Security Forms/ID Requested from Hirers 1:

Security Forms/ID Requested from Hirers 2:

Security Forms/ID Requested from Hirers 3:

Hire Terms:

Are any vehicles plated (for Taxi use):

Fleet Cover & Submit Quote

Cover Date:

Level of Cover

Parking Post Code:

Current Insurer:

Best Quote Received:

XS:

Claims & Claims Experience

No of claims (within 3 years)

Total Cost of claims

Is a copy of your claims experience available:

Further notes: