Motor Enquiry Form

		For enquiries please call 01-8797100
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Online Motor Enquiry Form

Simply complete your details below and one of Halligan Insurances experienced staff will contact you to arrange your motor quotation over the phone.

Personal Information		* Indicates required field
Title^*		Address^*
First Name^*
Surname^*		Town^*
Date of Birth^*		County^*
Employer^*		Occupation^*
Email^*		Phone Number^*

Insurance Policy Information
Motor Insurance Renewal Date^*
House Insurance Renewal Date

Data Protection Declaration
I hereby consent to the use and recording of my personal details (contained herein or provided subsequently) by Halligan Insurances. I understand that the details I have provided will be held on computer and/or in printed form or otherwise by Halligan Insurances. I agree that this information may be used in the future to contact me by mail/email/telephone/mobile phone/SMS about Halligan Insurances services which may be of interest to me. I understand that the information provided by me will not be passed on to third parties for the purposes of direct marketing. I also understand that I may at no cost instruct Halligan Insurances in writing to no longer hold my data for the purpose of sending me such information and that I have the right of access to and the right to rectify the data concerning me held by Halligan Insurances.