Page 65 - VACC Membership Kit 2023

Registration of interest (for insurance quotation)
Business trading name Division
Type of business
Address
Contact name Contact number Current insurer
I do not currently have insurance My business (please tick):
Has a reception area
Has a showroom/sales area (if yes number of vehicles on floor) Has a workshop (if yes, number of vehicles capacity)
Carries stock inventory
Provides courtesy vehicles (number of vehicles)
(e.g. Mechanical repair; Smash repair; Auto electrical; Specialised repair; Engine reconditioning; Automatic transmission; Towing business; Car/Motorcycle sales; Tyre retailer/wholesaler)
Postcode
Renewal Date (day/month)
/
Brokered by Jardine Lloyd Thompson Pty Limited ABN 69 009 098 864 AFS Licence No: 226827
Any advice in this document is general and may not be suitable to your circumstances.
Please fax or email this form to
OurAuto Insurance
03 9614 3600 contact@ourautoinsurance.com.au
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