ghbc Limited trading as Towergate ghbc insurance brokers offering commercial and personal insurance services to business and private clients in the South east and throughout Britain

QUOTATION REQUEST FORM

We would be pleased to give you a quotation without charge or obligation. Whether you are unhappy with your current insurance arrangements, arranging insurance for the first time, or looking at possible alternatives, we can provide a fast and accurate quotation for your consideration.

Please answer as many of the following questions as you can — fields marked with an * are mandatory fields and must be answered

Your Name *

Company Name

Your Address

Post Code *

Your Mobile Number

Your Telephone *

Email Address *

The Class of Insurance you are interested in. *

Commercial

	Biofuels Insurance		Management Liability
	Blocks of Flats		Marine Cargo
	Business Insurance		Motor Fleets
	Commercial Vehicles		Professional Indemnity
	Contractors All Risks		Property Owners
	Directors & Officers		Public Liability
	Employers Liability		Shops/Offices
	Insurance Due Diligence		Small Business
	Let Property		Technology
	Listed Property		Other

Personal

High Value Homes

Listed Property

Current Insurer

Next renewal date

Other Notes

We would like to contact you from time to time about products and services (or with news, offers, services and promotions) that we feel may be of interest to you. By providing us with your contact details, you consent to being contacted by these methods for these purposes.

Please tick the box if you prefer not to receive marketing communications from us by
post or telephone.

Please tick the box if you prefer not to receive marketing communications from us by email, text messaging or other electronic means

We will acknowledge this quotation by email within 2 working days of its receipt.

Contact us for further information

Management Liability - Financial protection for your management team

Technology - Cover for unique IT industry risks

Property Owners - For owners, managers and developers

Listed Property - Specialist insurance cover for listed buildings

Towergate ghbc is a trading name of Towergate Underwriting Group Limited and is authorised and regulated by the Financial Services Authority.
You can check our details on the FSA register (www.fsa.gov.uk/register) under Firm Reference Number 313250