Insurance Quotation Request Form
About You
*Title
*First Name
*Surname
*Street Address
*Postcode
Contact Telephone
*Email Address
*Date of Birth(dd/mm/yyyy)
Sex
*Occupation
*Business Type
*Status
Are you a member of a caravan club?
How many years caravan no claims bonus available?
Caravan Details
Is the caravan a tourer?
Is the caravan single or twin axle?
*Make
*Model
Is the caravan imported?
*Date of Manufacture(yyyy)
Date of Purchase(dd/mm/yyyy)
Is the caravan used for business?
Is the caravan used as a permanent residence?
*Risk Street Address
*Risk Postcode
Security and Safety
*Mule
*Tyreon Bands
*Factory Fitted Alarm
*Hitch Post
*Active Tracker
*Datatag
Storage
*CaSSOA Storage
Cover Details
*Value of Caravan and Fittings £
(includes awnings and gas bottles etc.)
*Personal Possessions £
(max £3000 or 200 of caravan value)
*Date cover required for
What's the best quote you've had elsewhere?
Is the Property:
Free from Flood?
Within One Mile of a River/ a Quarry/ the Sea?
Let for Hire and Reward?
Contacting You
To process your quote we may need to share your personal data within the Adrian Flux Insurance Services group and its trusted agents, however:
We may also share your details with selected third parties so that they may tell you of products and services which we or they think may interest you, by telephone, sms, email or post. The personal information you provide may also be used for the purposes of: identity verification, credit and risk management, revenue collection, database verification and enhancement. If you would prefer your information not to be used in these ways, please tick this box: