Business Insurance Quotation Request

Thankyou for your interest in Bendigo Business Insurance. To obtain a quotation or to get advice from a Business Insurance Consultant, please complete the details below. This quotation service for Bendigo Business Insurance is provided by CGU Insurance.

Note: Only fields marked with * are compulsory.

Your Details
Your Name or Business Name *
Contact Person
Do you wish to be contacted now? * If you wish to be contacted at a later date (eg: when you receive your current business insurance policy renewal) please provide a date:	Yes Once you have sent us your request, you will be contacted by a Business Insurance consultant within 48 hours. No at a later date / /
Contact Address: *
		Street Address
		Suburb
		State
		Postcode
Contact Phone Numbers: *
		Work
		Home
		Mobile
Your Email Address: *
Preferred Contact Time: *	(Service can be provided from Mon - Fri, 8:30am - 5:30pm Eastern Standard Time.)

Banking Details
Are you already a Bendigo Bank Customer?	Yes No
If Yes, which Branch of the Bendigo Bank do you bank with?

Your Business Information
Suburb/Town where your business is located: *
State: *
Postcode: *
Industry/Occupation Type:
What type of Insurance cover do you require to protect your business?
Is your business currently protected with another Insurance provider?	Yes No
If yes, who is your current Insurance company (if known)?
Expiry Date:	/ /
Are there any special circumstances we should know about your business?
Are there any other details you would like to tell us about?

Confirmation of Your Referral to CGU Insurance.

Protecting Your Privacy Protecting Your Privacy

Bendigo and Adelaide Bank Group ("we") collects your personal information to provide a quote on the insurance products and services you have requested. To do that, we may need to disclose your personal information to CGU Insurance Limited, insurance reference services, mailing houses, electronic network administrators, information technology service providers and introducers that carry out functions on Bendigo and Adelaide Bank Group's behalf ("service providers"). If any part of that information is not provided, we may not be able to provide you with a quote on the insurance products and services you have requested. In most cases, you can gain access to your personal information.

Yes, I have read and agreed to the Privacy Declaration.

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