Eazy Insure

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0330 113 9854

Motor Trade Quotation Form

Online

Phone

How did you hear about us?

If by a friend, family or referrer please state their name

Have you or any of the drivers ever had insurance declined, cancelled or special terms imposed? *

“Registered with the ICO, all your personal information is protected under the Data Protection Act 2018”

Personal Info

Title *

First Name *

Surname (Including any middle names) *

Date of Birth *

House Number/Name *

First Line of Address *

Postcode *

Trading Address - (if different)

Contact Info

Email address *

Mobile *

Phone

Please contact me via

Phone

Text

Driving History

Type of License *

Period Licence held for *

If held for 3 years or less, what date was licence obtained

Please enter your 16-character GB driving licence number *

This may reduce your price

Any motor accidents (fault or non-fault) or claims (whether claim made or not) in the last 5 years *

Motor Accidents or Claim Details

1

Type:

Date:

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

Yes

2

Type:

Date :

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

Yes

3

Type:

Date :

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

Yes

4

Type:

Date :

Damage:

Cost(£) - if known:

Fault:

Any Injuries:

Yes

In the last 5 years, has the driver had any motoring offences, including fixed penalties, convictions, driver awareness courses or disqualifications, or any pending prosecutions? *

Motor Conviction, Fixed Penalty or Disqualification Details

1

Conviction Code:

Date of Conviction:

Points:

Fine(£) - if any:

Ban(months) - if any:

2

Conviction Code:

Date of Conviction:

Points:

Fine(£) - if any:

Ban(months) - if any:

3

Conviction Code:

Date of Conviction:

Points:

Fine(£) - if any:

Ban(months) - if any:

4

Conviction Code:

Date of Conviction:

Points:

Fine(£) - if any:

Ban(months) - if any:

Vehicle Details

Do you do only Buying & Selling or vehicle recovery as well?

Do you do trading from home?

Yes

Are you trading as Limited Company or Sole Trader?

Do you have a trading name?

Do You have a Recovery Truck?

Yes

If yes, what’s the make & model

Have you ever had a Motor Trade policy before or this is first time?

Yes

If yes who was your insurer previously

Approximately how many cars you sell in a month

Vehicle Registrations at present you hold

What’s the projected turnover for your business?

How many cars do you keep at a time in your possession?

Do you keep the car on the road or in the Driveway or Garage?

If you have garage or driveway’ how many cars it can hold at a time

What is the level of indemnity?

What’s the maximum individual value of the cars you hold?

Do you require demonstration cover?

Yes

Do you sale any Motor Bike, HGV, Classic or Sports cars or any vehicle over 3.5 ton?(If yes’ please specify)

What type of cover you prefer?

Do you have No Claim Bonus on Motor Trade policy?

Yes

Would you like to pay ‘monthly or one off’ for your insurance

When would you like the policy to start?

Additional Driver

Would you like to add another additional driver

Yes

Additional Comments

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By clicking submit, you agree your explicit consent for us to use the data provided in accordance with the Data Protection
act 2018, this data will be used to provide the cheapest possible quote while being shared with both offline and online markets.

Independent Price Searcher To Compare Your Quotes

Motor Trade Quotation Form

Personal Info

Contact Info

Driving History

Motor Accidents or Claim Details

1

2

3

4

Motor Conviction, Fixed Penalty or Disqualification Details

1

2

3

4

Vehicle Details

Additional Driver

Additional Driver (1) Details

Motor Accidents or Claim Details

1

2

3

4

Motor Conviction, Fixed Penalty or Disqualification Details

1

2

3

4

Additional Driver (2) Details

Motor Accidents or Claim Details

1

2

3

4

Motor Conviction, Fixed Penalty or Disqualification Details

1

2

3

4