Registration Form for a New Broker

To become a Sportscover Accredited Broker, there are a number of criteria that your company must fulfil including areas such as Information Technology, Complaints Procedures, Geography, Credit history and References. Please complete the following registration form to be submitted to the Underwriting Panel for consideration.

Completion of this form is an Application only and does not guarantee accreditation.

 

Broker Details
Broker Name	required
Contact Name	required
Email	required error
Telephone (Home)
Telephone (Business)	at least one number
Fax
Website	error
ABN
Broker Address
Address Line 1	required
Address Line 2
Suburb	required
State	VIC NSW QLD ACT TAS NT SA WA
Postcode	required
Contact Address
	Same as Above
Address Line 1	required
Address Line 2
Suburb	required
State	VIC NSW QLD ACT TAS NT SA WA
Postcode	required
Business Information
Broker Member	Are you a member of a broker group?YesNo please select Please provide details. required
Sports & Business	What Sports and leisure business do you currently have? required
Sports & Business Outlook	What Sports and leisure business are you targeting in the next 12 months? required
Verification Code	required New Code