Agency Allianz - Franck Haloche

Agency Allianz - Franck Haloche

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Pet insurancePet Insurance Form

To receive a quotation for Pet Insurance, please fill in the following details and click SEND. We will then respond to you as soon as possible.

YOUR PET
     
Dog or Cat:  
Name:
 
Date of Birth:  
Sex:  
Cross breed?  
Breed?  
Sterilized?  
If tattooed or chipped, please give identification number  
Are their vaccinations up to date?  
Do they have a hereditary illness?  

OWNER
     
Your Firstname & Surname:
 
Date of Birth:  
Address:
 
Telephone:
 
Email Address:
 
     
     
FORMULA  
How did you hear about us?  
     
   
     
Quotation in French only?  
     
 
 
Please call us on 0033 (0)2 43 05 21 82 if you have any problem with this form
     
   
     

 

Agency Allianz - Franck Haloche

1 rue Louis Blériot
Parc d’activités des Sémondières
53500 ERNEE
France


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Tel: 0033 (0)2 43 05 21 82
EMail: 4005417@agents.allianz.fr