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EMAIL Or FAX
Thank you for considering our on-line general equipment
/ tools of trade insurance quote service. Brokers National has accounts with
most insurers and underwriting agencies. We aim to find you the best general equipment
/ tools of trade 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.
Defined Perils: Fire, Flood, Damage Due To Collision & Overturning Of The Vehicle, Including Theft From Securely Locked Vehicle Or Buildings By Forcible & Violent Entry. OR
Accidental Damage: Above Defined Events Plus Accidental Loss Or Damage
Exclusions: Buildings & Motor Vehicles Must Be Locked, & Vehicles Are Not To Be Parked In The Street Overnight
| Occupation / Trade / Business: |
| Business / Trading Name: | ||
| Company, Or Partnership Names |
| Total Sum Insured For All Items To Be Covered: | $ |
| Limit Anyone Item Unless Specified Below: | $ | 1,000 per item |
| Specified Items Over $1,000 per item | $ |
| Period of insurance required: | From To | |
| Geographical boundaries of insurance: | Victoria Australia World Wide |
| Suffered any loss during the past 5 years from any events that you wish to insure for? | Yes No | |
| Been refused insurance? | Yes No | |
| Been quoted an increased premium? | Yes No | |
| Had special terms imposed? | Yes No | |
| Been charged or convicted of any offence involving dishonesty of any kind? | Yes No |
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Contacting you about your quote:
| Please make sure you leave a contact phone number and the best time to call you. |
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