Online Quote Request
Before completing this form we would point out that the ‘total policy cost’ for insurance cover generally starts at $700.00 but this can increase depending on the policy type required.

After you have completed and submitted the form, one of our brokers will contact you within one working day. In order to provide you with a quote for the appropriate level of cover, there is certain information that we need from you. Supplying this information in this form enables us to provide you with a faster service. Your information will not be used for any other purpose.

*First Name
*Surname
Company Name
*Town/Suburb
*Postcode
*Annual Turnover	< Please Select > Less than $50,000 $50,000 - $100,000 $100,000 - $200,000 $200,000 - $300,000 $300,000 - $500,000 $500,000 - $1,000,000 More than $1,000,000
*Number of Workers (including principals)	< Please Select > 1 2-5 5-25 25-50 50-200
*Company Activities (please give a brief description of your main business activities, and any other information you think relevant)
*Type of Insurance required	Boat Insurance Business Packages Commercial Motor / Fleet Car Insurance Construction - Contract Works Commercial & Domestic Strata Plans Landlord / Property Owners Director's and Office Liability Farm Insurance - Including Hobby Farms Home & Contents Insurance Machinery - Computer insurance Marine Transit Insurance- Cargo - Inland - Imports/Exports World Wide Public and/or Products Liability Professional Indemnity Trades Package - Electricians-Plumbers-Carpenters-Builders-Cleaners       and more
*Amount of Cover Required	$
*Contact Telephone
*Email Address
*Preferred Contact Method	Telephone Email Please email me periodically about related services
*Have you received any other quotes?	No Yes - From whom?
*denotes required fields