Trade Credit Insurance Quote Request

Thank you for your interest in Trade Credit Insurance. To help us provide you with an accurate and competitive quote, please complete the form below with as much detail as possible. The information you provide will assist us in understanding your business operations, credit exposures, and any past losses.

All information provided in this form is treated as strictly confidential and will be used solely for the purpose of assessing your Trade Credit Insurance requirements. At Coverforce, we are committed to protecting your privacy in accordance with the Privacy Act 1998 (Cth). A copy of our Privacy Policy is located on our website, which you can read here . Alternatively, you can obtain a copy from our Privacy officer by emailing compliance@coverforce.com.au.

If you have any questions while completing this form, feel free to contact us — we’re here to help.

TIP - You can click "save and complete later" at the bottom of this form if needed

Legal Entity Name *

ACN or ABN *

Company Website

Contact Name *

Email Address *

Phone Number *

What was your business turnover for the last 12 months *

Less than $15MMore than $15M

What is your estimated turnover from credit customers over the next 12 months *Please exclude GST, government contracts, and customers not on credit terms.

Please list your top credit customers, minimum of 6, maximum of 10. Click the add customer button to add a new line.

Entity Name *

ACN or ABN *

Dollar Limit Required *

What losses have you incurred over the last 3 years from customers who were placed into administration or liquidation. Include losses that were recovered. Only list those above $2500. Click the Add Loss button to add a new line.

Entity Name *

ACN or ABN *

Total Loss Amount *

Amount Recovered

Please upload your current Aged Receivables Trial Balance, showing amounts owning in current, 30 days, 60 days, 90 days and over 90 days. Accepted file types include doc, docx, xls, xlsx, pdf, no larger than 20MB. *

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How many years has your business been operating? *

Please describe the main activities of your business *

Additional Comments

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