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Buckler Insurance Services
Personal
Automobile Insurance
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Home Insurance
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Seasonal Residence Insurance
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Motorcycle Insurance Ontario
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Motorcycle Insurance
Name:
(Required)
Email
Address:
City:
Province:
Postal Code:
Phone Number:
(Required)
Age:
License no:
M1 License Date:
MM slash DD slash YYYY
M2 License Date:
MM slash DD slash YYYY
M License Date:
MM slash DD slash YYYY
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:
Previous Insurance Company:
Modified or Customized:
Yes
No
Do you belong to any Riders Associations or Clubs:
Yes
No
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