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 Brokers National 

At Brokers National we can assist your group with quotes for accident insurance                                             Simply answer the questions below and we will obtain quotations for you                                               

EMAIL Or FAX: 

On-Line Group Accident Insurance Quote


Thank you for considering our on-line group accident insurance quote service. Brokers National has accounts with most insurers and underwriting agencies. We aim to find you the best group accident  insurance deal possible.

Please fill in the following form - answering all questions, then either:

1. Click on "Email to Brokers National" at the bottom of this form.  OR                               

2. Highlight this form to "Print It" and then "Fax It" to our office on 03 9791 6633.


 Use the Mouse or the Tab key to move to the next field. We will respond with quotes as soon as they have been received from our insurers.

Contacting you about your quote:

Please make sure you leave a contact phone number and the best time to call you.
Your Name:
Company name:
Your Phone Number & Area Code:
Best Time(s) To Call:
Please send my quote by (select at least one): email     phone     fax     mail
Your Email:
Your Facsimile:
Your Postal Address:

Click On Email Quote To Send         Form To Us

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