Removalist Registration

Company Name

Primary Trading Name

ABN

What business name would you prefer us to display to customers?

This is the name that we will display in the CARTS products quote pages for the customers to tell us who referred them

Contact Name

First

Last

Registered Address

City

State

Postcode / ZIP Code

Country

Is this also the Postal Address?

Yes No

Postal Address

City

State

Postcode / ZIP Code

Country

Phone (Landline)

Phone (Mobile)

Email Address (Contact)

Website Address

Do you currently refer or discuss insurance related questions with your customers?

Yes No

Years in business

Years

Number of vehicles

Do you use Sub Contractors?

Yes No

What type of Contents do you usually Carry?

Household Personal Effects

Commercial/Industrial (ie; Office, Factory relocations)

Freight Transporter

Importer/Exporter

Details of General Freight carried: (ie; Clothing, Machinery, Chemicals)

Any other information that you think might help us understand your business (ie What Type of Insurances your Business currently holds where we could assist related to CARTS):

Bank

Name of Account

BSB

Account Number

Quote Ref:

Underwritten by:

Coverforce Complete Insurance Brokers Pty Ltd.

Phone 1300 880 253
Fax +61 (03) 9887 2361
Email insure@removalsinsurance.com.au

Postal Address
PO Box 6118, Wantirna, VIC 3152