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Ford Kinter

Head Office:

1 - 3 Smolic Crt, Tullamarine,
Victoria 3043, Australia

PH. (03) 9339 3333
Fax. (03) 9339 3355

Toll Free 1800 810 392

info@fordkinter.com.au

Motor Quotation Form

MOTOR INSURANCE QUOTATION FORM

Please fill in the details below for a quotation or click here for us to contact you


Fields marked with an * are required fields.

Details
Make (e.g. Ford): *
Model (e.g. Falcon XR6): *
Body Type (e.g. Sedan): *
Year: *
Engine Size:
Number of Cylinders: *
Vehicle Value: *
Accessories (Value of Non-standard): *
Policy Type:
Agreed Value  
Market Value  
Goods carried: Yes     No  
Suburb Vehicle Parked:*
Night / Home Parking?
Garage / Security Parking  
Carport  
Driveway  
Parking Lot  
On Street  
Do you Drive to Work?   Yes     No  
Day Away Parking
Garage / Security Parking  
Driveway / Street  
Private Parking Lot  
Parking Lot  
Railway Station  
Shopping  
None  
Usage
Business Use  
Reg. Bus / Used Private  
Private / Occasional Business  
Only Private  
Finance   Yes     No  
Hire Purchase  
Corporate Hire Purchase  
Bill of Sale  
Chattel Mortgage  
Finance Co.  
Bank Loan  
Credit Union  
Unsecured Finance  
Personal Loan  
Is the Financiers Name to be noted on the Policy?   Yes     No  
Standard Excess   Yes     No  
Do you wish to remove or increase the excess on the policy?   Yes     No  
If Yes - What excess do you wish to pay?:*
Date of Birth:*
or Age:*
Gender?   Male     Female  
No Claims Bonus:   1 - 6 years     6 years or more  
How many years has insured held max NCB?:*
How long has main driver had Australian Drivers Licence?:*
Do you want NCB Protection?:   Yes     No  
Nominated / Restricted Driver:   Yes     No  
Are you currently Insured?:   Yes     No  
If Yes - with whom?:*
Alarm :
No Alarm  
Audible Alarm Only  
Ignition Kill Switch  
Full No Go / Immobiliser  
Steering Lock  
Tracking System  
Distance Driven per Year? (approx):*
Contact Details
Name:*
Company:*
Position:*
Postal Address:*
Suburb / Town:*
State:*
Postcode:*
Phone:*
Fax:*
Email:*
Comments:



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Melbourne, Sydney, Brisbane, Darwin, Adelaide, Hobart, Australia

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