|
| I confirm that I have read the FloriGuard website
privacy statement
(tick box) |
| I confirm that I have read the FloriGuard Capacity and Services information
(tick box) |
| I agree to receiving marketing information from
Bridge Insurance Brokers Ltd or from selected business partners
|
| Name: |
|
| Trading name: |
|
| 1st line of address: |
|
| Postcode: |
|
| Are you a member of the British Florist Association? |
|
| Contact Telephone Number |
|
| Email Address |
|
| Number of years trading |
|
Type of business: |
|
How many working Proprietors / Partners / Directors are there: |
|
| Do you require Employers Liability Cover: |
|
| IF YES: |
|
| How many Clerical employees are there: |
|
| How many Manual employees are there: |
|
| Tools and Transit Cover required: |
|
| Business Equipement Cover (kept within the property): |
|
| Stock Cover (kept within the property): |
|
| What limit of Public Liability is required: |
|
| Have there been any incidents in the last three years which
have or could result in a claim? |
|
| If yes, please provide details: |
|
| Date: |
(dd/mm/yyyy) |
| Value: |
£ |
| Describe circumstances: |
|
| Date: |
(dd/mm/yyyy) |
| Value: |
£ |
| Describe circumstances: |
|
| Who is your current insurer? |
|
| When is cover required? |
(dd/mm/yyyy) |
| What are you currenly paying? |
£ |
| Any further information: |
|
IMPORTANT: In order for us to process your
quotation please confirm that you understand the assumptions made to provide you with a
fast quotation. By ticking the box you confirm that you
have read and agree with the statements click
here to view
NOTE: If information provided
is incorrect or incomplete Insurers may not pay your claim.
Details you provide may be checked by Insurers against data
held elsewhere. |
Please contact us on 0845 313 9871 if you
cannot proceed any further. |
|
