Business Cover Quotation Form - The Retail Mutual

Please answer all questions accurately and to the best of your knowledge. You must also tell us about any risks your business faces and anything that affects or might affect your cover. We will contact you as soon as we can with a quote.
Name*
Title First Name Surname
Home Address
Street Address Address Line 2 City County Postcode
Primary Phone Number*
Mobile Phone Number
Email Address
Date of Birth

Please answer all questions accurately and to the best of your knowledge. You must also tell us about any risks your business faces and anything that affects or might affect your cover.
Organisation Type
Trading Name
Business Type
Please Specify
Renewal date
Do you carry out any other business at the premises?
- Yes
- No
Please give details
Business address to be covered
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
How many years have you run this business or a business of a similar nature?
Estimated annual turnover for the next year
Estimated annual wage roll for the next year

Please answer all questions accurately and to the best of your knowledge. You must also tell us about any risks your business faces and anything that affects or might affect your cover.
Do you require public and products liability cover?
- Yes
- No
How much cover would you like?
- £2,000,000
- £5,000,000
Do you require employers’ liability cover – this will cover you up to £10,000,000
- Yes
- No
What is your ERN number?
- Tick here if exempt from ERN