Cofton Insurance Services

Commercial Insurance


Motor Quotation Form

Please complete the enquiry form below to receive a quotation.

Please try to fully complete this form as any omissions may affect the quotation given. Upon completion please press the "Submit Details" button to proceed remembering to include your preferred method of contact, email, fax or telephone.

We aim to provide a fast response to your enquiry and will endeavour to acknowledge receipt of your enquiry the same day.

Before completing the form please read the Terms of Business. If you have any queries please contact us.

Motor Trade Quotation Form (Road Risks)
Motor Trade Quotation Form (Road Risks)

 

Full Name

Age

Trading Name

(if applicable)

Home address

 

Post Code

Telephone No.

Email

Contact Method

Details about your business

Trading from?

Do you require cover for vehicles at your premises?

If yes please state postcode

Are you Trading Full Time or Part Time?

 

If Part Time please answer the next two questions

Full Time Occupation

 

Self- Employed?

Yes

No

Your Motor Trade Activities (must add up to 100%)

Buying & Selling

%

Valeting

%

Mechanical Repairs

%

Mobile Operation

%

Accident Repairs

%

Collection & Delivery

%

Vehicle Recovery

%

Vehicle Part Sales

%

Please detail your involvement with the following vehicle types (must add up to 100%)

Family Saloons

%

Sport/High Performance

 %

Vans (up to 3.5t)

 

%

Vans (up to 7.5t)

 %

Motorcycles

%

Minibuses/Coaches

 %

Modified/Kit Cars

%

Classic Cars

 %

Imports

%

Scrap/Salvage

 %

Other

(Please State)

Drivers (This insurance is on a named driver basis only, please give details of all drivers including the proposer)

Name

Date of Birth

Licence

Date passed test

Trade Status

Use

Claims (Please list details of any claims/accidents/losses or thefts for any driver in the last 3 years)

If there are NO claims for any driver please indicate by ticking this box

Driver

Date of Incident

Costs

Details

Convictions (please list details of any motoring convictions in the last 5 years)

If there are NO convictions for any driver please indicate by ticking this box

Driver

Conviction Date

Fine

  Offence Code

Disqualification period (if applicable)