Insurance Quotation Request Form For Inflatable Hirers
       
Company Name(*):    
Contact Name (*): Telephone(*):
Address: Fax:
Town(*): Email(*):
Postcode:    
       

   
 
Do you require Public Liability cover?

If Yes - What is your Indemnity Limit
     
 
Do you require Employers Liability cover?
If Yes - Please estimate the company's annual wages for the next 12 months £
     
 
Do you require Material Damage cover on your equipment?
If Yes - Please confirm the total Replacement with New Value of all equipment £
     
 
How many years have you been trading?
  Years
     
     
 
Have you ever had an Insurance claim, or an incident
which would have resulted in a claim, had you had this insurance?
 
     
 
When is your next Insurance Renewal Date?
  DD/MM/YYYY     
(if you do not currently have insurance tick this box)
   
 
Are your Terms and Conditions signed for as accepted by the Hirer?
 
 

  Please give details below of the equipment which you operate:        
                 
 
Type/Description
of equipment
Is use limited to
under 15's
Are these units hired
"dry"?
Number of these Units
 
 
 
 
 
 
 
 
 
 
  Below please let us know about any material facts or other information which might be important to Underwriters, or if any further explanation is required regarding the items of equipment you hire out.
   
 
                 
 
   
 
 

I have read and agree with Terms of Business