Broker Application


COMPANY DETAILS

Company Name:
Address:
 
 
 
 
Town / City:
 
County:
 
 
Country:
 
Postcode:
Website:
 
 
Telephone Number:
 
Fax Number:
 

CONTACT DETAILS

Title:
 
Forenames:
Surname:
Contact phone number:
Alternative contact number:
Position:
Email address:
Current client 'back office' administration system:
 

YOUR COMMENTS / CATEGORY REQUESTS

If you would like to provide further information or suggest alternative categories please do so in the comments box below:

Comments / Suggestions for new categories of insurance to be added to QuoteRack:
 

QUOTE REQUESTS

Please provide the email address that you would like all Quote Requests sent to below:

Quote Email address:
 
Receive part completed Quote Requests?
Just like normal leads you will only be charged for requests that have a genuine need and provide valid contact details.
 

Part completed leads cost 50% less than the full lead price, yet come with the same assurance that, if you aren't happy that it's a genuine prospect you won't be expected to pay for it.

CATEGORY SELECTION

All currently available categories and the cost per quote request you receive for that category are listed below. If you don't see the category you require please let us know in the comments box provided.

Please select the categories that you specialise in from the list provided below by placing a tick in the appropriate boxes (Your selections can be changed at a later date):

NB. Please be aware that categories marked as unavailable can still be selected and you will be placed on a waiting list.

Business
Cost Per Lead
  • Alarm installers liability insurance
    		•  £10.00
  • Architects liability insurance
    		•  £6.00
  • Arts and crafts insurance
    		•  £1.00
  • Blocks of flats insurance
    		•  £6.00
  • Business liability insurance
    		•  £6.00
  • Camping site business insurance
    		•  £6.00
  • Caravan site business insurance
    		•  £6.00
  • Care home insurance
    		•  Unavailable
  • Charity insurance
    		•  £6.00
  • Driving school insurance
    		•  £6.00
  • Entertainment insurance
    		•  £6.00
  • Event cancellation insurance
    		•  Unavailable
  • Ex-offenders business insurance
    		•  Unavailable
  • Financial advisors
    		•  £6.00
  • Firework display insurance
    		•  Unavailable
  • General tradesmen insurance
    		•  £6.00
  • Goods in transit/hauliers liability insurance
    		•  £6.00
  • Hairdresser salon insurance
    		•  Unavailable
  • Hazardous materials business insurance
    		•  £6.00
  • HGV and haulage insurance
    		•  £6.00
  • Hotel, B&B and guest house insurance
    		•  £6.00
  • Insurance brokers
    		•  £6.00
  • Landlords property and legal insurance
    		•  £6.00
  • Leisure industry
    		•  £6.00
  • Licensed trade - pubs, bars and off-licences
    		•  £6.00
  • Manufacturing insurance
    		•  £6.00
  • Marine, freight and cargo insurance
    		•  £6.00
  • Motor fleet insurance (5+ vehicles)
    		•  £11.00
  • Motor trade - road risks
    		•  £6.00
  • Motor trade - with commercial premises
    		•  Unavailable
  • Multiple events insurance (Annual Policy)
    		•  Unavailable
  • Music event liability insurance
    		•  Unavailable
  • Musicians insurance
    		•  £6.00
  • Nightclubs, casinos and adult clubs
    		•  £6.00
  • Office contents insurance
    		•  £6.00
  • One-off event or show insurance
    		•  Unavailable
  • Performing artists
    		•  £6.00
  • Professional indemnity insurance
    		•  £6.00
  • Restaurants and takeaways insurance
    		•  £6.00
  • Right to manage (RTM) flats and apartments
    		•  £6.00
  • Security companies
    		•  Unavailable
  • Shop insurance
    		•  £6.00
  • Solicitors' insurance
    		•  £6.00
  • Sports event insurance
    		•  Unavailable
  • Stockbrokers and investment managers cover
    		•  £6.00
  • Surgery, clinic and practice insurance
    		•  £6.00
  • Taxi office business insurance
    		•  Unavailable
  • Vacant business premises insurance
    		•  £6.00
  • Van couriers insurance
    		•  £3.75
  • Wedding insurance
    		•  Unavailable
  • Wholesaling business insurance
    		•  £6.00
  • Working from home insurance
    		•  £3.00
    Car
    Cost Per Lead
  • 4x4 car insurance
    		•  £3.00
  • Agreed value car insurance - cars aged 10+ years
    		•  £3.00
  • American car insurance
    		•  £3.00
  • Aston Martin car insurance
    		•  £3.00
  • Bentley car insurance
    		•  £3.00
  • Bugatti car insurance
    		•  £3.00
  • Car Insurance – standard risk vehicle / drivers
    		•  Unavailable
  • Classic car insurance
    		•  £3.00
  • Combined car and home insurance
    		•  £3.75
  • Company-owned car insurance
    		•  £3.75
  • Disabled drivers' car insurance
    		•  £1.00
  • Drink-drive car insurance
    		•  £3.00
  • Drivers with accidents or convictions
    		•  £3.00
  • Driving instructor insurance
    		•  £3.75
  • Ex-company car insurance
    		•  £3.00
  • Female driver car insurance
    		•  Unavailable
  • Ferrari car insurance
    		•  £3.00
  • Fleet motor insurance (5+ vehicles)
    		•  £11.00
  • Gap insurance
    		•  £3.00
  • Grey import car insurance
    		•  £3.00
  • High risk occupation driver
    		•  £3.00
  • High value car insurance £50,000+
    		•  £3.00
  • Jaguar car insurance
    		•  £3.00
  • Kit-car insurance
    		•  £3.00
  • Lamborghini car insurance
    		•  £3.00
  • Left hand drive car insurance
    		•  £1.00
  • Limited mileage car insurance
    		•  £3.00
  • Lotus car insurance
    		•  £3.00
  • Maserati car insurance
    		•  £3.00
  • McLaren car insurance
    		•  £3.00
  • Minibus insurance
    		•  £3.00
  • Modified car insurance
    		•  £3.00
  • Motor trade insurance - road risks
    		•  £6.00
  • Noble car insurance
    		•  £3.00
  • Over 50's car insurance
    		•  £3.00
  • Polish driver car insurance
    		•  Unavailable
  • Porsche car insurance
    		•  £3.00
  • Private hire car insurance
    		•  £3.75
  • Professional footballer car insurance
    		•  Unavailable
  • Quadbike insurance
    		•  Unavailable
  • Rare or non-ABI listed car insurance
    		•  £3.00
  • Rolls-Royce car insurance
    		•  £3.00
  • Self-drive hire car insurance
    		•  Unavailable
  • Short period car insurance
    		•  Unavailable
  • Sports car insurance
    		•  £3.00
  • Sportsman/woman car insurance
    		•  Unavailable
  • Taxi insurance
    		•  £3.75
  • TV / Film / Radio celebrity car insurance
    		•  £3.00
  • TVR car insurance
    		•  £3.00
  • Young driver (< 25) high performance car insurance
    		•  £1.00
  • Young driver (under 25 years old) insurance
    		•  £1.00
    Challenge QuoteRack (Priced by category)
    Cost Per Lead
  • Challenge QuoteRack
    		•  £0.00
    Health
    Cost Per Lead
  • Age 50+ health insurance
    		•  Unavailable
  • Company health insurance schemes
    		•  Unavailable
  • Leaving a company health insurance scheme
    		•  Unavailable
  • Pre-existing condition health insurance
    		•  Unavailable
  • Previous claims health insurance
    		•  Unavailable
  • Private health insurance
    		•  Unavailable
    Home
    Cost Per Lead
  • Adverse claims history home insurance
    		•  £3.00
  • Annexe and granny-flat insurance
    		•  Unavailable
  • Blocks of flats insurance
    		•  £6.00
  • Buy-to-let and let property insurance
    		•  £6.00
  • Combined home and car insurance
    		•  £3.75
  • Converted property insurance
    		•  £3.00
  • Ex-offenders home insurance
    		•  Unavailable
  • Fine art, antiques and valuables home insurance
    		•  Unavailable
  • Flood plain home insurance
    		•  Unavailable
  • Freehold flat home insurance
    		•  £3.00
  • High value home insurance (high net worth)
    		•  £3.00
  • Home insurance (standard buildings and contents)
    		•  £3.00
  • Hotel, B&B and guest house insurance
    		•  £6.00
  • Landlords property and legal insurance
    		• £6.00
  • Listed property home insurance
    		•  £3.00
  • Non-standard construction home insurance
    		•  £3.00
  • Over 50's home insurance
    		•  £3.00
  • Overseas holiday home insurance
    		•  £3.00
  • Park home insurance
    		•  £3.00
  • Right to manage (RTM) flats and apartments
    		•  £6.00
  • Self-build property insurance
    		•  £3.00
  • Sportsman/woman home insurance
    		•  Unavailable
  • Student possessions insurance
    		•  £3.00
  • Subsidence and underpinned property insurance
    		•  Unavailable
  • Thatched roof home insurance
    		•  £3.00
  • Timber frame home insurance
    		•  £3.00
  • UK second home insurance
    		•  £3.00
  • Unoccupied property home insurance
    		•  £3.00
  • Vacant business premises insurance
    		•  £6.00
  • Working from home insurance
    		•  £3.00
    Leisure
    Cost Per Lead
  • Boat insurance
    		•  £2.75
  • Camping site business insurance
    		•  £6.00
  • Caravan site business insurance
    		•  £6.00
  • Dinghy insurance
    		•  £2.75
  • Fishing tackle insurance
    		•  £1.75
  • Jet ski and personal watercraft insurance
    		•  £2.75
  • Motorhome and campervan insurance
    		•  £2.75
  • Static caravan insurance
    		•  £2.00
  • Touring caravan insurance
    		•  £2.00
  • Trailer tent insurance
    		•  £2.00
  • VW camper van insurance
    		•  Unavailable
  • Yacht insurance
    		•  £2.75
    Life
    Cost Per Lead
  • Age 50+ life insurance
    		•  £6.00
  • Company pension schemes
    		•  £6.00
  • Critical illness protection
    		• Unavailable
  • Existing medical condition life insurance
    		•  Unavailable
  • Family history life insurance
    		•  Unavailable
  • Group income protection
    		•  Unavailable
  • Group life insurance
    		•  Unavailable
  • Hazardous pastimes life insurance
    		•  Unavailable
  • High risk occupation life insurance
    		•  Unavailable
  • High value life insurance cover
    		•  Unavailable
  • HM Armed Forces life insurance
    		•  Unavailable
  • Impaired life annuity
    		•  £6.00
  • Income protection insurance
    		•  Unavailable
  • Key man life insurance
    		•  Unavailable
  • Life insurance - standard
    		•  Unavailable
  • Mortgage protection
    		•  Unavailable
  • Non-standard mortgage protection
    		•  Unavailable
  • Pensions and annuities
    		•  £6.00
  • Previously rejected for life insurance
    		•  £6.00
  • Term assurance
    		•  Unavailable
    Mortgages and Loans
    Cost Per Lead
  • Commercial property mortgage
    		•  £20.00
  • Debt consolidation loan
    		•  £10.00
  • Debt consolidation mortgage
    		•  £20.00
  • First time buyer mortgage
    		•  £20.00
  • Loans for people with a poor credit history
    		•  £10.00
  • Mortgages for buy-to-let property
    		•  £20.00
  • Mortgages for people with a poor credit history
    		•  £20.00
  • Personal loans - unsecured
    		•  £10.00
  • Self-certification mortgages
    		•  £20.00
  • Standard mortgages and remortgages
    		•  £20.00
    Bike
    Cost Per Lead
  • Classic motorbike insurance
    		•  £1.00
  • Gap insurance
    		•  £3.00
  • Grey / personal import motorbike insurance
    		•  Unavailable
  • Modified motorbike insurance
    		•  Unavailable
  • Motorbike insurance
    		•  Unavailable
  • Poor driving record motorbike insurance
    		•  £1.00
  • Quadbike insurance
    		•  Unavailable
  • Rare or unlisted motorbike insurance
    		•  £1.00
    Pet
    Cost Per Lead
  • Horse and equestrian insurance
    		•  £2.00
  • Older pet insurance
    		•  £2.00
  • Standard pet insurance
    		•  Unavailable
  • Unusual or rare breed pet insurance
    		•  £2.00
    Sports Insurance
    Cost Per Lead
  • Car insurance (amateur sports)
    		•  Unavailable
  • Car insurance (disabled sports)
    		•  Unavailable
  • Car insurance (professional sports)
    		•  Unavailable
  • Equipment insurance (professional sports)
    		•  Unavailable
  • Equipment insurance (sports clubs/associations)
    		•  Unavailable
  • Home insurance (amateur sports)
    		•  Unavailable
  • Home insurance (disabled sports)
    		•  Unavailable
  • Home insurance (professional sports)
    		•  Unavailable
  • Professional footballer car insurance
    		•  Unavailable
  • Professional sports team health insurance
    		•  Unavailable
  • Sports equipment insurance (amateur sports)
    		•  Unavailable
  • Sports equipment Insurance (disabled sports)
    		•  Unavailable
  • Sports event - liability & cancellation insurance
    		•  Unavailable
  • Sports events (UK) - liability, cancellation
    		•  Unavailable
  • Sports liability insurance (EL and PL)
    		•  Unavailable
  • Sports premises - buildings and contents
    		•  Unavailable
  • Travel insurance (amateur sports)
    		•  Unavailable
  • Travel insurance (professional sports)
    		•  Unavailable
  • Travel insurance (sports - disabled)
    		•  Unavailable
    Travel
    Cost Per Lead
  • Annual travel insurance (multiple trips)
    		•  £1.00
  • Group travel insurance
    		•  £1.00
  • Hazardous or extreme sports travel insurance
    		•  £1.00
  • Over 60's travel insurance
    		•  £1.00
  • Personal accident insurance
    		•  £2.00
  • Pre-existing medical condition travel insurance
    		•  £1.00
  • Security guard travel insurance
    		•  Unavailable
  • Sports travel insurance - amateur/professional
    		•  Unavailable
  • Travel insurance - single trip
    		•  £1.00
  • Winter sports travel insurance
    		•  £1.00
    Commercial
    Cost Per Lead
  • Fleet motor insurance (5+ vehicles)
    		•  £11.00
  • Gap insurance
    		•  £3.00
  • Goods in transit/hauliers liability insurance
    		•  £6.00
  • HGV and haulage insurance
    		•  £6.00
  • Minibus insurance
    		•  £3.00
  • Mobile catering vans
    		•  Unavailable
  • Modified van insurance
    		•  Unavailable
  • Motorhome and campervan insurance
    		•  £3.00
  • Non-standard goods van insurance
    		•  £3.00
  • Non-standard or high-risk occupation van insurance
    		•  £3.00
  • Polish driver van insurance
    		•  Unavailable
  • 'Reach and Wash' van insurance
    		•  £3.00
  • Short period van insurance
    		•  Unavailable
  • Tradesman tools and equipment insurance
    		•  £2.00
  • Van courier insurance
    		•  £3.75
  • Van drivers with accidents or convictions
    		•  £3.00
  • Van insurance
    		•  £3.00
  • VW camper van insurance
    		•  Unavailable

     

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