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Motorcycle Insurance
Name
*
:
Email Address:
Address
*
:
City:
Province:
Postal Code:
Phone Number
*
:
Age:
License #:
M1 License Date:
Date and time
M2 License Date:
Date and time
M License Date:
Date and time
Did you take a Riders Training Course:
Yes
No
Any Tickets:
Yes
No
Any claims in last 6 years:
Yes
No
What Coverage are you looking for:
All perils
Collision
Comprehensive
Specified perils
Liability Limit:
$2,000,000
$1,000,000
Collision Deductible amount:
$250
$500
$1,000
Comprehensive Deductible amount:
$250
$500
$1,000
Specified Perils Deductible amount:
$250
$500
$1,000
Year, make and model:
Value of Bike:
Modified or Customized:
Yes
No
Previous Insurance Company:
Do you belong to any Riders Associations or Clubs:
Yes
No
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Did You Know
To lower your insurance premiums, consider raising your deductibles.
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