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 Brokers National 

Brokers National Looks Forward To Obtaining Truck & Heavy Motor Insurance Quotations For You                                      We Appreciate The Opportunity To Assist You                                       Did You Know We Also Help You If A Claim Occurs                                      Please Contact Our Office If You Have Any Questions                                       Thank You

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On-Line Heavy Motor Truck Insurance Quote


Thank you for considering our on-line heavy motor / truck insurance quote service. Brokers National has accounts with most insurers and underwriting agencies. We aim to find you the best commercial / business 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.

Heavy Motor / Trucks


 Details of vehicle/s:

Truck type:
Carrying capacity in tonnes:
Year, Make and Model of Truck:
Items of plant attached, e.g. crane:
:  
Items of plant attached to truck, e.g. crane:
Please make sure that the value of any accessory is included in the sums insured noted below e.g. CB, UHF, Phone, Self use fridge, Gates, Tarps, Dogs & Chains, Binders, Angles, Ropes, Plant; As these are included in the total sum insured automatically.
Trailer Type e.g. Flat top Dry Tautliner, Refrigeration Tautliner, Dry Pantech Refrigeration Pantech. Livestock, Tanker, Tipper, Convertible::
Year Trailer : Make/ Model Length Reg / Serial No.   Sum Insured
$
$
$
Items of plant attached to trailer, e.g. crane:

Please make sure that the value of any accessory is included in the sums insured noted below e.g. CB, UHF, Phone, Self use fridge, Gates, Tarps, Dogs & Chains, Binders, Angles, Ropes, Plant; As these are included in the total sum insured automatically.


 Details of operations:

What type of goods are carted?
Are any dangerous goods carted, if yes, please advise details?
What distance limit do you require? Radius
What are your normal freight earnings? OR $  
What is the insured's annual gross turnover? $

Details of owner:
Date of Birth
If applicable, state years of current experience in driving this class of vehicle: Years
How long has the insured been an owner?   Years


Driver information:

Full name of main driver:
Main Driver's Date of Birth

Advise type of vehicle / plant (e.g. prime mover or rigid / dozer or skid steer loader) driver and years experience:
Type of vehicle
  Experience
  Years
  Years
  Years
Please indicate below Yes or No:
Had any accidents in the past five years: Yes     No
Had any insurance claims in the past 5 years: Yes     No
Had license in suspended, cancelled or endorsed in any state in the past five years: Yes     No
Had any traffic offences in the past 5 years: Yes     No
Had any criminal convictions or insurance declined: Yes     No
Any physical defects / conditions that may affect your driving ability: Yes     No

If you have answered yes to any of these questions please give more details below:

 


Any other notes you wish to include:

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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