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About ATIA
Our Services
Transport and Logistics
Financial and Political Risk
Insurance Services
Subscribe
Resources
News
Risk Review
Claims
Frequently Asked Questions
Careers
Quotes
Transport Operators Insurance Quotation
Mobile Plant and Equipment Quote
Trade Credit Insurance
Landlords Insurance Quote
Home & Contents Quote
Motor Vehicle Quote
Premium Payments
Contact Us
Trade Credit Insurance Form
Full Name
*
Email
*
Phone
Business Name
Address
Street Address
City
State
Postcode
ACN / ABN
Business Established
Type of Goods Sold
Industry to whom goods are sold
Estimated Annual Credit Sales (Excl GST):
Terms of Payment
Accounts Spread (Credit Limits / Maximum Exposure)
Outstanding Balance at any one time/Number of Accounts
Up to $5,000
$5,001 - $15,000
$15,001 - $50,000
$50,001 - $100,000
$100,001 - $200,000
Over $200,000
Previous Bad Debts
Current Year
Total Losses $
Single Largest Loss $
Last Year
Total Losses $
Single Largest Loss $
Prior Year
Total Losses $
Single Largest Loss $
Please list your Top 10 Accounts
Name
ABN
Credit Limit Required
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