Hollard Lead Form

Start the process by completing the form

Share your client’s details and a Beame consultant will be in touch to explain all the benefits they get when signing up with Beame for Vehicle Recovery.

Simply complete the form to subscribe today.

"*" indicates required fields

Do you have a Personal or a Commercial insurance policy?*

Personal

Commercial

Name*

Surname*

Please enter either ID or Passport Number

ID Number

Passport Number

Company Registration Number*

Mobile Phone Number*

Enter Mobile Number e.g. 821111111
(leave out the 0 in front)

Confirm Mobile Phone Number

Email Address*

Enter Email Confirm Email

What is your Broker’s email address?*

Lead feedback will be sent to this email address

Policy Number*

Whilst mandatory, you can insert four zeros (0000) instead of the actual policy number

Download and complete the following documents:
- Service Agreement
- Credit Application (required for 5 and more vehicles)
Send the completed forms to hollard@mixtelematics.com

Which solution do you want to subscribe for?*

Beame – includes R59 per month (incl. VAT) subscription for stolen vehicle recovery (36-month agreement) plus free installation of a wireless Beame recovery device and Matrix App access.
Find out more www.beame.co.za/about/

Beame Advanced – includes R99 per month (incl. VAT) subscription for stolen vehicle recovery (36-month agreement) plus free installation of two wireless Beame recovery devices and Matrix App access. This is ideal for higher risk vehicles.
Find out more www.beame.co.za/about/

MiX Recovery Protect – includes R109 per month (incl. VAT) subscription for stolen vehicle recovery (36-month agreement) plus free installation of two Beame recovery devices (ideal for higher risk vehicles), a recovery warranty of up to R200,000 and Matrix App access.
Find out more www.mixrecoveryprotect.co.za

This field is hidden when viewing the form

SourcePartnerId|LeadId

The plain-text csv field of SourcePartnerId and LeadId which is used to create the encrypted id parameter for uploading of documents

Comments

This field is for validation purposes and should be left unchanged.

Ts & Cs Apply: By submitting the form, you agree to send your information to Beame to use according to our Privacy Policy.