Home | Website Name

Company Name

Reg. No. (optional)

Address

Products Sold

Trading Terms

Contact Name

Phone

Fax (optional)

Position

Confirm Email

Estimate of turnover to be insured for the next 12 months

Does this include exports? Yes No

Financial Period	Year to Date	Last Full Year	Previous Year	Previous Year
End Date (DD/MM/YY)
Actual Sales	£	£	£	£
Bad Debt Losses	£	£	£	£
No. of Losses	£	£	£	£
Largest loss	£	£	£	£

Do you have an existing credit insurance policy? Yes No

Please estimate how many customers you sell to on credit

List your top 5 customers (please enter either the town or the company registration number)