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Name:
Date Of Birth:
Company name:
Email:
Telephone:
How many years Trading:
Where do you trade from:
Please Select
Home
Premises
Mobile
Premises Postcode (home if N/A):
Describe in detail your occupation:
First line of your address:
Do you buy and sell cars:
No
Yes
Do you repair cars (bodywork):
No
Yes
Do you repair cars (mechanical):
No
Yes
Are you a car valeter:
No
Yes
How many employees do you have:
What do you estimate your annual turnover to be - not profit - turnover:
How much do you expect to pay in wages to employees - allow minimum of £10,000 per employee:
Does your work involve soldering, welding, blow lamps or similar:
No
Yes
Has anyone ever made a claim against you:
No
Yes
Anti Spam:
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