Broker Application


COMPANY DETAILS

Company Name:
Address:
 
 
 
 
Town / City:
 
County:
 
 
Country:
 
Postcode:
Website:
 
Landline Phone No:
 
Fax Number:
 

CONTACT DETAILS

Title:
 
Forenames:
Surname:
Contact phone number:
Alternative contact number:
Position:
Company email address:
FSA reference number:
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.
 
Accept leads from the follow regions:
 



FREE TRIAL

You will not be charged for any QuoteRack leads supplied to you during your Free Trial period.

Please note that the granting of a Free Trial is at the discretion of QuoteRack Ltd and may be suspended, restricted or cancelled at any time without notice or explanation.

The number and type of categories of leads available for your selection may be restricted during the Free Trial period.

In all cases, QuoteRack Ltd’s decision is final

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
    		•  £6.00
  • Architects liability insurance
    		•  £6.00
  • Arts and crafts insurance
    		•  £6.00
  • Bed and breakfast insurance
    		•  £6.00
  • Blocks of flats insurance
    		•  £6.00
  • Business liability insurance
    		•  £6.00
  • Camping site business insurance
    		•  £6.00
  • Car boot sale insurance
    		•  £3.00
  • Caravan site business insurance
    		•  £6.00
  • Care home insurance
    		•  Unavailable
  • Charity insurance
    		•  £6.00
  • Chip shop / takeaway insurance
    		•  Unavailable
  • Commercial property insurance
    		•  £6.00
  • Door supervisors / security guard insurance
    		•  £6.00
  • Driving school insurance
    		•  £6.00
  • Entertainment insurance
    		•  £6.00
  • Ex-offenders business insurance
    		•  Unavailable
  • Farm Insurance
    		•  Unavailable
  • Financial advisors professional indemnity
    		•  £6.00
  • Firework display insurance
    		•  Unavailable
  • Fleet motor insurance (2 - 5 vehicles)
    		•  £7.50
  • Fleet motor insurance (5+ vehicles)
    		•  £11.00
  • General tradesmen insurance
    		•  £6.00
  • Goods in transit/hauliers liability insurance
    		•  £6.00
  • Hairdresser salon insurance
    		•  £6.00
  • Hazardous materials / toxic waste insurance
    		•  £6.00
  • HGV and haulage insurance
    		•  £6.00
  • Hotel and guest house insurance
    		•  £6.00
  • Landlords property and legal insurance
    		•  £6.00
  • Leisure industry
    		•  £6.00
  • Licensed trade - bars, clubs and off-licences
    		•  £6.00
  • Manufacturing insurance
    		•  £6.00
  • Marine, freight and cargo insurance
    		•  £6.00
  • Motor trade - road risks
    		•  £3.00
  • Motor trade insurance - with business 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 insurance
    		•  £6.00
  • One-off event or show insurance
    		•  Unavailable
  • Performing artists
    		•  £6.00
  • Professional indemnity insurance
    		•  £6.00
  • Pub insurance
    		•  £6.00
  • Restaurant insurance
    		•  £6.00
  • Right to manage (RTM) flats and apartments
    		•  £6.00
  • Roofers and scaffolders insurance
    		•  £6.00
  • Security companies
    		•  £6.00
  • Shop insurance
    		•  £6.00
  • Snooker, pool and billiard hall insurance
    		•  £6.00
  • Solicitors' insurance
    		•  £6.00
  • Sports event insurance
    		•  £6.00
  • Stockbrokers and investment managers cover
    		•  £6.00
  • Surgery, clinic and practice insurance
    		•  £6.00
  • Taxi fleet insurance
    		•  £11.00
  • Taxi office business insurance
    		•  £6.00
  • Vacant business premises insurance
    		•  £6.00
  • Van couriers insurance
    		•  £3.75
  • Wedding insurance
    		•  Unavailable
  • Wholesale business insurance
    		•  £6.00
  • Working from home insurance
    		•  £3.00
    Car
    Cost Per Lead
  • 4x4 car insurance
    		•  £3.00
  • American car insurance
    		•  £3.75
  • Aston Martin car insurance
    		•  £3.00
  • Bentley car insurance
    		•  £3.00
  • Bugatti car insurance
    		•  £3.00
  • Car breakdown cover
    		•  £2.00
  • Car Insurance – standard risk vehicle / drivers
    		•  £3.00
  • Chauffeur hire insurance
    		•  £3.75
  • Classic car insurance
    		•  £3.00
  • Combined car and home insurance
    		•  £3.75
  • Company-owned car insurance
    		•  £3.75
  • Custom car insurance
    		•  £3.00
  • Disabled drivers' car insurance
    		•  £3.00
  • Drink-drive car insurance
    		•  £3.00
  • Drivers with accidents or convictions
    		•  £3.00
  • Driving instructor insurance
    		•  £6.00
  • Ex-company car insurance
    		•  £3.00
  • Ex-offenders car insurance
    		•  Unavailable
  • Female driver car insurance
    		•  £1.00
  • Ferrari car insurance
    		•  £3.00
  • Fleet motor insurance (2 - 5 vehicles)
    		•  £7.50
  • Fleet motor insurance (5+ vehicles)
    		•  £11.00
  • Gap insurance
    		•  £3.00
  • Grey / personal import car insurance
    		•  £3.75
  • 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
  • LPG conversion car insurance
    		•  £3.00
  • Maserati car insurance
    		•  £3.00
  • McLaren car insurance
    		•  £3.00
  • Minibus insurance
    		•  £3.00
  • Modified car insurance
    		•  £3.00
  • Monthly 'pay as you go' car insurance
    		•  Unavailable
  • Motor trade insurance - road risks
    		•  £3.00
  • Noble car insurance
    		•  £3.00
  • Off-road 4x4 vehicle 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
    		•  £3.75
  • 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
    		•  £2.00
  • Sports car insurance
    		•  £3.00
  • Sportsman/woman car insurance
    		•  £3.00
  • Taxi fleet insurance
    		•  £11.00
  • Taxi insurance
    		•  £3.75
  • TV / Film / Radio celebrity car insurance
    		•  £3.00
  • TVR car insurance
    		•  £3.00
  • Wedding hire car insurance
    		•  £3.75
  • 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
  • Serious illness cover
    		•  Unavailable
    Home
    Cost Per Lead
  • Adverse claims history home insurance
    		•  £3.00
  • Annexe and granny-flat insurance
    		•  Unavailable
  • Barn conversion insurance
    		•  Unavailable
  • Bed and breakfast insurance
    		•  £6.00
  • 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
  • Estate insurance
    		•  Unavailable
  • Ex-offenders home insurance
    		•  Unavailable
  • Fine art, antiques and valuables home insurance
    		•  Unavailable
  • Flat insurance
    		•  £3.00
  • Flood risk home insurance
    		•  Unavailable
  • Foster carers home insurance
    		•  Unavailable
  • Freehold flat home insurance
    		•  £3.00
  • High value home insurance (high net worth)
    		•  £3.00
  • Home emergency cover
    		•  Unavailable
  • Homeowners buildings and/or contents insurance
    		• £3.00
  • Hotel 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
  • Property renovation insurance
    		•  £3.00
  • Right to manage (RTM) flats and apartments
    		•  £6.00
  • Self-build property insurance
    		•  £3.00
  • Sportsman/woman home insurance
    		•  £3.00
  • Student possessions insurance
    		•  £3.00
  • Subsidence and underpinned property insurance
    		•  Unavailable
  • Thatched roof home insurance
    		•  £3.00
  • Timber frame home insurance
    		•  £3.00
  • TV/film/radio celebrity property insurance
    		•  Unavailable
  • 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 - cruisers, narrowboats and barges
    		•  £2.75
  • Camping site owners insurance
    		•  £6.00
  • Caravan site owners insurance
    		•  £6.00
  • Dinghy insurance
    		•  £2.75
  • Dinghy insurance - sailing, rowing and inflatables
    		•  £2.75
  • Fishing tackle insurance
    		•  £1.75
  • Jet-ski insurance
    		•  £2.75
  • Mobile home / static caravan insurance
    		•  £2.00
  • Motorhome and campervan insurance
    		•  £3.75
  • Touring caravan insurance
    		•  £2.00
  • Trailer tent insurance
    		•  £2.00
  • VW camper van insurance
    		•  £3.75
  • Yacht insurance
    		•  £2.75
    Life
    Cost Per Lead
  • Age 50+ life insurance
    		•  £6.00
  • Company director life insurance
    		•  Unavailable
  • 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
  • Pension release for ages 54 - 65
    		•  £6.00
  • Pensions and annuities
    		•  £6.00
  • Previously rejected for life insurance
    		•  £6.00
  • Serious illness cover
    		•  Unavailable
  • Shareholder protection
    		•  Unavailable
  • 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
  • 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
  • Non-standard construction mortgages
    		•  £20.00
  • Personal loans - unsecured
    		•  £10.00
  • Personal loans - unsecured
    		•  £10.00
  • Self-certification mortgages
    		•  £20.00
  • Standard mortgages and remortgages
    		•  £20.00
    Bike
    Cost Per Lead
  • Classic motorbike insurance
    		•  £3.00
  • Ex-offenders motorbike insurance
    		•  Unavailable
  • Gap insurance
    		•  £3.00
  • Grey / personal import motorbike insurance
    		•  £3.00
  • Mobility scooter insurance
    		•  Unavailable
  • Modified motorbike insurance
    		•  £1.00
  • Motorbike insurance
    		•  £3.00
  • Motorcycle breakdown cover
    		•  Unavailable
  • Poor driving record motorbike insurance
    		•  £1.00
  • Quadbike Insurance
    		•  £3.00
  • Rare or unlisted motorbike insurance
    		•  £1.00
  • Scooter & moped insurance
    		•  Unavailable
    Pet
    Cost Per Lead
  • Horse and equestrian insurance
    		•  £3.00
  • Older pet insurance
    		•  Unavailable
  • Pet insurance
    		•  Unavailable
  • Unusual or rare breed pet insurance
    		•  £2.00
    Sports Insurance
    Cost Per Lead
  • Car insurance (amateur sports)
    		•  £3.00
  • Car insurance (disabled sports)
    		•  £3.00
  • Car insurance (professional sports)
    		•  £3.00
  • Equipment insurance (professional sports)
    		•  £1.00
  • Equipment insurance (sports clubs/associations)
    		•  £3.00
  • Home insurance (amateur sports)
    		•  £3.00
  • Home insurance (disabled sports)
    		•  £3.00
  • Home insurance (professional sports)
    		•  £3.00
  • Professional footballer car insurance
    		•  £3.75
  • Sports equipment insurance (amateur sports)
    		•  £1.00
  • Sports equipment Insurance (disabled sports)
    		•  £1.00
  • Sports event - liability & cancellation insurance
    		•  £6.00
  • Sports events (UK) - liability, cancellation
    		•  £6.00
  • Sports liability insurance (EL and PL)
    		•  £6.00
  • Sports premises - buildings and contents
    		•  £6.00
  • Travel insurance (amateur sports)
    		•  £2.00
  • Travel insurance (professional sports)
    		•  £2.00
  • Travel insurance (sports - disabled)
    		•  £2.00
    Travel
    Cost Per Lead
  • Annual travel insurance (multiple trips)
    		•  £1.00
  • Group travel insurance
    		•  £1.00