Company Validation Check

If you have a company code, please enter, if you do not have a code please call us on 03333 446645

Step 1 - Vehicle Details

 

Disclaimer: When adding multiple vehicles, vehicle 1 must be the highest level of cover required.

Vehicle {{$index + 1}}:

{{vehicle.registration}}

{{vehicle.model}}

{{vehicle.make}}

Level {{vehicle.package.index}} - {{vehicle.package.name}}

Please select the required cover for this vehicle

{{vehicle.package.startDate}} - {{vehicle.package.endDate.toDate() | date:'dd MMMM yyyy'}}

{{(vehicle.package.slots[vehicle.index].price * (vehicle.package.duration > 0 ? vehicle.package.duration : 1)) | currency:"£" }}


Total Cost - {{totalCoverCost() | currency:"£" }}

Step 2 - Personal Details
First Name line is required. First Name can be no longer than 250 characters.
Surname can be no longer than 250 characters.
Address line is required. Address line can be no longer than 250 characters.
Address line can be no longer than 250 characters.
Town is required. Town can be no longer than 250 characters.
Postcode is required. Postcode can be no longer than 250 characters.

Address Data will only be used for Payment Proccessing and not be stored by Vehicle Benefits

Step 3 - Contact Details
Primary Email is required. Primary Email can be no longer than 250 characters.
Primary Email is required. Primary Email can be no longer than 250 characters. Primary Emails do not match
Secondary Email is required. Secondary Email can be no longer than 250 characters.
Secondary Email is required. Secondary Email can be no longer than 250 characters. Secondary Emails do not match
Telephone line is required. Telephone line can be no longer than 250 characters.
Password must contain 1 lower case and 1 upper case letter a number and a symbol.
Confirmation Password is required. password line can be no longer than 25 characters. Password must contain 1 lower case and 1 upper case letter a number and a symbol. Passwords do not match
Step 4 - Cover Type Summary

 

Vehicle {{$index + 1}}:

{{vehicle.registration}}

{{vehicle.package.level}}

{{vehicle.package.levelShortDescription}}

{{vehicle.package.levelDescription}}

Covered till: {{vehicle.package.validTo}}

{{vehicle.package.startDate}} - {{vehicle.package.endDate.toDate() | date:'dd MMMM yyyy'}}


Total Cost of Cover: {{total | currency:"£"}}

Step 5 - Payment

Payment card details are not stored in the system

Card Holder Name line is required. Card Holder Name can be no longer than 250 characters.