BMW Quotation

You might also like

Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

FFOORR U

ULLYYSSSSIIAANNSS ––
BYY U
B ULLYYSSSSIIAANNSS

Greenslip Quotation

Insurer CIC Allianz Insurance Limited


Reference Number 21826

Name Laurie Gallagher

23 Petken Drive
Garaging Address
Taree NSW 2430

Postal Address As Above


Ulysses Membership No 53531
Email Address laurieg88@hotmail.com
Phone Number 6551 4916
Date of Birth
Registration Number
Year of Motorcycle 2004
Make and Model BMW R1150RT
Engine Capacity 1130
Registration Due Date 14/06/2009
Vin/Chassis/Engine No.
Premium $313.00
Credit Card Type
Credit Card Number
Name on Credit Card
Expiry Date

*Premium includes GST and MCIS Levies

85 Andrew Thompson Drive Phone: 02 4577 8507


McGraths Hill NSW 2756 Fax: 02 8580 4981
Email: info@monaland.com.au Mobile: 0449 870 100
Web: www.monaland.com.au ABN 90 129 148 616

You might also like