Request transport insurance

For making you an offer, please send us back the filled questionnaire.

For further information or if you have any questions please do not hesitate to contact us. Phone call or mail is enough.

Request transport insurance

Holder/Owner

Policyholder*

Street, house number*

Postal code, place*

Telefon*

Fax

E-Mail*

Value vehicle(s) and supplies

Type of vehicle

Name of the vehicle

Time value vehicle(s) in EUR*

Time value supplies in EUR*

Transport vehicle

Type of the transport vehicle

Duration of insurance

Please select

Please enter the number and destination of the rides here

Other comments

Additional information please specify here

Confirmation

Please read our privacy policy before sending.

Confirmation*

Yes, I have read the privacy policy and I agree that the data I provide will be collected and stored electronically. My data is used only strictly earmarked for processing and answering my request. I agree that all correspondence will be sent by e-mail. I agree that the e-mails will be sent unencrypted (normal e-mail) and declare that I have understood this notice. By submitting the form I agree with the processing.

Declaration*

I confirm the accurancy of the information above.

Don't fill this field!

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Request transport insurance

Request transport insurance

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