Company Name

Address

Postcode

Date Established

MAIN CONTACT INFORMATION
Title
Mr Mrs Miss Ms Dr  
First Name

Last Name

Telephone Number

Mobile Number

Fax Number

 E-mail address

     Body                    
Repairs/Service                     Spraying 
    %                       %
Vehicle Sales                     Vehicle Sales
    (NEW)                                 (USED)
    %                       %
                                            Valeting /  
MOT Testing                  Steam Cleaning
    %                       %
Car Breaking /                      Vehicle
     Scrap                            Deliveries
    %                       %

Home
Workshop
Showroom with forecourt
Mobile
Other (please describe)

Comprehensive TP Fire and Theft Third Party only

1 2 3 4 5+

Motor Trade Commercial Vehilce Motor Cycle Private Car

 Sports/Prestige                    
 /Performance                   Motorcycles 
    %                       %
Veteran/Vintage           Small Commercials
    /classic                          (Under 7.5T)
    %                       %
                                      Large Commercials
 American                          (over 7.5T)
    %                       %
Caravans /                          Kit Cars or
Motorhomes                   Modified Vehicles
    %                       %
                                           Scrap or
 Agricultural                        Salvage
    %                       %

NAME                              DATE OF BIRTH        

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