Apply to become an affiliate

To apply for our affiliate program, please fill in the form below and a member of our Affiliate Team will contact you shortly.


Your Details...

The name of the person who will be the named contact on the affiliate agreement.
The email address of the person who will be named on the affiliate agreement..
The business telephone number of the person who will be named on the affiliate agreement.
The mobile telephone number of the person who will be named on the affiliate agreement.

Company Details...

The name of the company that will be named on the affiliate agreement.
The address of the company that will be named on the affiliate agreement.
The postcode of the company that will be named on the affiliate agreement.
The web address of the website that will be named on the affiliate agreement.
Please enter your company status.
Please enter your registered Ltd company number as it appears on Companies House.
Please list all company directors here.
Please provide your category of business. For example; Motor Trader, Garage, Insurance Broker.
Please enter if your company is FSA registered.
If applicable please enter your FSA firm reference number.
Please select which insurance product you are interested in.
If applicable please enter any additional products that you are interested in.
Please enter if insurance is incidental to your business.
Best Date To Contact You?
Type the date in format dd/mm/yyyy or click to use the popup calendar

Date must be between 17/05/2012 and 16/06/2012
Please tell us your preferred contact method.


an award winning company

Award-winning insurance broker

Winner

Insurance Times Awards 2010

Personal Lines Broker of the Year

Call now for a great quote

0800 061 2959

Autonet Insurance Group is a trading name of Autonet Insurance Services Limited. Registered in England No. 3642372. Registered office, Nile Street, Burslem, Stoke-On-Trent ST6 2BA. Member of the Institute of Insurance Brokers. Authorised and Regulated by the Financial Services Authority, under firm reference number 308213, you may check this on the FSA register by visiting the FSA website, www.fsa.gov.uk/pages/register or by contacting the FSA on 0845 6061234.  Terms and Conditions  |  Privacy Policy  |  Sitemap  |  XML Sitemap