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Fleet
Printable Version

Same Day Quick Quote Form...

Target Premium


Date Cover Required



Broker Details...

Broker


Branch


Postcode


Telephone


Facsimile


Email


Contact



Quote Details...

Client


Company


Street No.


Postcode


Existing Client
Yes
No

Type of Business


Years Established


Excess Amount - Min £100


State Type of Cover Required



Partners/Directors...

Name
Age










































Quote Details...

Use Required (All policies Include Social, Domestic & Pleasure) - Please Tick as Required


SD&P including personal business

Business Purposes excluding Goods

Class 2

Class 3

Business Purposes including the carriage of own Goods

Business Purposes including the carriage of other peoples Goods

Business Purposes - Private Hire

Business Purposes - Public Hire

Where carried, state nature of Goods carried including any Hazardous Goods...




Please answer - Yes or No as applicable...

Will any vehicles be used abroad for Business
Yes
No

Are Drivers permitted to take vehicles home at night
Yes
No

Where are vehicles stored overnight?


Radius Restriction



Vehicle Details...

Vehile 1
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 2
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 3
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 4
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 5
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 6
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 7
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 8
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 9
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 10
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 11
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 12
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 13
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 14
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 15
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 16
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 17
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 18
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 19
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:



Vehile 20
Vehicle Make


Model


C.C. Or G.V.W.


Seating Capacity inc. Driver


Max. Indemnity Value


Registration No:




Driver Details...

Driver Age Band



Give details of any driver with accident, claim or loss within the last 3 years, stating
circumstances and costs including outstanding estimates or attach latest claims experience...



Give details of any driver with a medical condition...



Fleet Management - tick all that apply...



Driver application forms



Driving licence inspected



Vehicle tracking



Safe Driving initiatives




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CompuQuote is a trading name of Bollington Underwriting Ltd   |   Unit 26, Hampstead Avenue, Mildenhall, Suffolk  IP28 7AS