sample

[php]

 

Accept Quotation and Make Payment











Please use a valid phone number


Please use a valid email address






” >












You have read and understood the Terms & Condition
Yes
No

You acknowledge that this is an application for insurance, and that Freight Insurance Services International will review the application and respond to you via email as soon as possible within 2 business days.

You also confirm that the details outlined in the application for insurance are accurate and correct to the best of your knowledge.

If this application requires an urgent response please contact our office on 03 9559 3308.

Freight Insurance Services International reserves the right to withdraw any quote at any time if it deems so.

Freight Insurance Services International takes no responsibility for errors or omissions within this website.

[/php]