The
orange boxes
are required fields.
Title
Select
Mr
Mrs
Miss
Ms
Dr
Prof
* Required
First Name
* Required
Surname
* Required
Date of Birth
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
Year
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
* Day Required
* Month Required
* Year Required
* You must be at least 18 years old to request a quote
South African ID Number
* Required
* Enter a valid ID Number
Day-Time Contact Number
(Format: 0#########)
* Required
* Incorrect format
E-mail
* Required
* Please enter a valid email address
Daytime Postal Code or Suburb
* Select a suburb/city from the list that appears as you type
Occupation
Occupation
Director – Admin
Director – Manual / Mechanical
Director – People and Admin
Driver
General Administrator
Machine Worker
Manager – Admin
Manager – Industrial
Manager – People
Manual – Engineering
Manual – Industrial
Manual – Office
Miner
Other – Administrative Work
Other – Manual Work
Other – Supervisory Work
Professional – Doctor
Professional – Engineering
Professional – Finance
Professional – Medical Specialist
Professional – Pilot
Sales – Sale Consultant
Sales – Sales Manager
Technical Occupation
* Required
Gender
Male
Female
* Required
Highest Education
Education
No Matric
Matric
Matric plus 1 or 2 Year Diploma
3 or 4 Year Technical or College Diploma
University Undergrad Degree
Future Professional
4 Year Degree
Post Grad
Not Available
* Required
Household Income
Income (per month)
0 - 5000
5001 - 10000
10001 - 15000
15001 - 20000
20001 - 22500
22501 - 25000
25001 - 32000
32001 - 41666
41667 - 55000
55001 - 67500
67501 - 80000
80001 - upwards
* Required
In which Regional Area do you live?
Tip
-- Select --
Area A
Area B
* Area Required
Details of Quad Bike 1 or Off-Road Bike 1
Tip
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Market Value
< 37000
38000
39000
40000
41000
42000
43000
44000
45000
46000
47000
48000
49000
50000
51000
52000
53000
54000
55000
56000
57000
58000
59000
60000
61000
62000
63000
64000
65000
66000
67000
68000
69000
70000
71000
72000
73000
74000
75000
76000
77000
78000
79000
80000
81000
82000
83000
84000
85000
86000
87000
88000
89000
90000
91000
92000
93000
94000
95000
96000
97000
98000
99000
100000
101000
102000
103000
104000
105000
106000
107000
108000
109000
110000
111000
112000
113000
114000
115000
116000
117000
118000
119000
Type of Bike
Quad
Please fill in all the fields correctly
* Please fill in the details of at least 1 vehicle
Details of Quad Bike 2 or Off-Road Bike 2
Tip
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Market Value
< 37000
38000
39000
40000
41000
42000
43000
44000
45000
46000
47000
48000
49000
50000
51000
52000
53000
54000
55000
56000
57000
58000
59000
60000
61000
62000
63000
64000
65000
66000
67000
68000
69000
70000
71000
72000
73000
74000
75000
76000
77000
78000
79000
80000
81000
82000
83000
84000
85000
86000
87000
88000
89000
90000
91000
92000
93000
94000
95000
96000
97000
98000
99000
100000
101000
102000
103000
104000
105000
106000
107000
108000
109000
110000
111000
112000
113000
114000
115000
116000
117000
118000
119000
Type of Bike
Quad
Please fill in all the fields correctly
Details of Quad Bike 3 or Off-Road Bike 3
Tip
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Market Value
< 37000
38000
39000
40000
41000
42000
43000
44000
45000
46000
47000
48000
49000
50000
51000
52000
53000
54000
55000
56000
57000
58000
59000
60000
61000
62000
63000
64000
65000
66000
67000
68000
69000
70000
71000
72000
73000
74000
75000
76000
77000
78000
79000
80000
81000
82000
83000
84000
85000
86000
87000
88000
89000
90000
91000
92000
93000
94000
95000
96000
97000
98000
99000
100000
101000
102000
103000
104000
105000
106000
107000
108000
109000
110000
111000
112000
113000
114000
115000
116000
117000
118000
119000
Type of Bike
Quad
Please fill in all the fields correctly
Details of Quad Bike 4 or Off-Road Bike 4
Tip
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Market Value
< 37000
38000
39000
40000
41000
42000
43000
44000
45000
46000
47000
48000
49000
50000
51000
52000
53000
54000
55000
56000
57000
58000
59000
60000
61000
62000
63000
64000
65000
66000
67000
68000
69000
70000
71000
72000
73000
74000
75000
76000
77000
78000
79000
80000
81000
82000
83000
84000
85000
86000
87000
88000
89000
90000
91000
92000
93000
94000
95000
96000
97000
98000
99000
100000
101000
102000
103000
104000
105000
106000
107000
108000
109000
110000
111000
112000
113000
114000
115000
116000
117000
118000
119000
Type of Bike
Quad
Please fill in all the fields correctly
Area A
- Gauteng, Vaal Triangle, Secunda Area, Witbank, Middleburg, Brits Area, Rustenburg Area
Area B
- All other areas
Please make sure you enter the Make and Model of your Quad Bike or Off-Road Bike in the space provided after the Year dropdown
For example -
Kawasaki KXF700
(Make Model)