Our Privacy Statement, Terms and Conditions and other important documents are those on which we intend to rely and for your own benefit and protection we urge you to read these carefully before proceeding. If you do not understand any point please ask for further information.

I agree to receiving marketing information from Bridge Insurance Brokers Ltd or from selected business partners Yes No

Name:

Salutation:

Please Select Mr Mrs Miss Ms Lord Lady Other

Trading name:

1st line of address:

Postcode:

Are you a member of the British Florist Association?

Please select Yes Yes through Society Yes, through a relay No I'm thinking of Joining

Contact Telephone Number

Email Address

Number of years trading

Please select Under 1 Year 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years Over 10 Years

Type of business:

Sole Trader Limited Company Partnership Other

How many working Proprietors / Partners / Directors are there:

1 2 3 4 5 6 7 8 9 10 More than 10

Do you require Employers Liability Cover:

Please select Yes No

If Employers Liability is required - How many Clerical employees are there:

Please Select 1 2 3 4 5 6 More

If Employers Liability is required - How many Manual employees are there:

Please select 1 2 3 4 5 6 More

Business Equipment Cover:

Please select Not Required £2,500 £5,000

Stock Cover (kept within the property):

Please select Not Required £1,000 £2,000

What limit of Public Liability is required:

Please select £1,000,000 £2,000,000 £5,000,000

Have there been any incidents in the last five years which have or could result in a claim?

Please select Yes No

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 currently 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

Tick here Please contact us on 0845 313 9871 if you cannot proceed any further.

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.