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On-demand Insurance Solutions

 

Step 1 of 4

WinBEAT Application Form
  1. Company Details
  2. Company Name*
    Required
  3. Trading as
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  4. ABN*
    Required.
    Enter your ABN here without spaces.
  5. Company Phone*
    Required
  6. Company Fax
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  7. Company Website
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  8. Company Street Address
  9. Address Line 1*
    Required
  10. Address Line 2
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  11. City/Suburb*
    Required
  12. State*
    Required. Select State from dropdown.
  13. Postcode*
    Required
  14. Country*
    Required
  15. Company Postal Address
  16. Same as Company Street Address?
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  17. Address Line 1*
    Required
  18. Address Line 2
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  19. City/Suburb*
    Required
  20. State*
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  21. Postcode*
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  22. Country*
    Required
  23.  
  1. Details of Primary Contact
  2. First Name*
    Please type your first name.
  3. Last Name*
    Please type your last name (surname).
  4. Position*
    Please enter your position/role.
  5. Phone*
    Invalid Input
  6. Email*
    Required.
    A confirmation receipt will be sent to this email address for reference.
  7. Company Type
  8. Type of business*



    Required
  9. AFS Licence Number*
    Required. Please Enter Your AFS Licence Number.
  10.  
  1. Application Type
  2. Number of User Levels (seat licences) for WinBEAT Required*
    Required. Enter integer value.
    This is the maximum number of users able to log into a WinBEAT portfolio at any one time. User Levels may be increased or decreased at any time. WinBEAT subscription rates are based on the User Level.
  3. Desired Contract Start Date
  4. What system are you currently using? (if Applicable)
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    eg: BrokerPlus, BrokerAdvantage, Custom
  5. Do you require a quotation for a conversion of your existing data?
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    For businesses utilising other broking systems wishing to switch to WinBEAT. Data from existing systems can usually be converted and imported into WinBEAT eliminating manual conversions.
  6. Electronic Trading via Sunrise Exchange
  7. Do you require a Sunrise Exchange connection?*
    Required
  8. Do you currently use Sunrise Executive*
    Required
  9. Do you require a quote to convert your information to Sunrise Exchange*
    Required.
  10.  
  1. Other
  2. Are you a member of any of the following groups?








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  3. How did you find out about WinBEAT







  4. Please Specify
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  5. Comments
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  6. Captcha
  7. Privacy Policy*
    Your understanding and acceptance of our Privacy Policy is required before proceeding.
  8.   
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