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Rider date of birth
Gender
Postcode where bicycle is kept
Bicycle type
Bicycle value
 

Become our referrer

Cycling is growing at an exciting rate in Australia with close to 1.5 million bicycles sold in 2007, a staggering 38% more than cars. We and our bicycles face certain perils associated with riding, which is why your customers will more than likely be interested in cycling specific insurance.

By registering as a Velosure referrer you can earn additional income by means of referring customers. We will provide you with marketing materials you can display on your website or in your bricks and mortar shop. Fill in the online form and we'll contact you with more details.

How to become a referrer

You can download, complete and mail back our registration form or you can apply online by filling in the details below. As soon as we have registered your details on our system we will send you marketing materials and website script. It usually takes up to a week for you to receive the materials. If you'd like to follow up at any time, just ring us on 1300 VELOSURE.

Registration application

The information provided in this application will be treated as strictly confidential and will not be supplied to any other company or organisation.

Retailer details
Store trading name Store legal name
Store address Postcode
Number of retail outlets Number of staff
Contact name Position
Telephone Fax
Email Website address
Name of webmaster Webmaster email
Submit Details

Questions? Email CustomerCare@Velosure.com.au