Cycle of the Quote Form process

*Fill in all areas *Get an indicative quote *Accept quote *Pay premium *You are then issued Interim Cover

Please note: Because of the high volume of Fast Track Truck Insurance Quotes we process on a daily basis, for us to meet our commitment to you, we require our quote form to be completed in its entirety. Failure to do so, may result in a deferral of your request.



Name (required)

Phone No (required)

Email (required)

Business Name

Date Insurance required from

Suburb and postcode where vehicle is based?

From home base, what is the furthest point you are likely to travel?
km.
What is your total litres of fuel used each month?
litres.
Would you be interested in saving 4 cents per litre off your fuel bill by using our fuel discount card?
YesNo
Goods Carried

Hazardous Goods
YesNo
Refrigerated
YesNo
How many years have you had continuous Commercial Truck insurance?

Are you the only driver?
YesNo
Age of youngest driver

What type of Truck License do you hold?

How many employees/drivers?

What type of truck do you drive?

Truck Details - Year / Make / Model / Required Sum Insured / Vehicle Carrying Capacity

Do you require cover for earthmoving equipment?
YesNo
If yes, what type of equipment and what value?

Current Insurer

Years in Business

No Claim Bonus %

Any claims in the last 5 years? Give details

Any Suspensions/convictions in last 5 years?

Any comments/further information?

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