Motorcycle Insurance Quote Sheet

 We make Insurance Easy and Affordable!

 

Ryde Insurance Agency is a full service motorcycle insurance agency. In order to match you with the  right insurance company for you and find you the coverage you need, please fill out this quote sheet. Required fields are marked by a blue asterisk (*). Use the tab key or mouse to navigate this form. When you are done,  submit this form ( submit button at bottom of form) and we will contact you. Please fill out all required fields. 

 

Insured's Information

 *Last Name   
*First Name  
Middle Initial
 Street Address    Where Bike is Garaged
City or Town  
State
*Zip Code  
*Date of Birth     Your Age Today
Occupation
*Social Security #   * Required for rating
*Driver License #   * Required for rating
Work Phone
Home Phone
Cell Phone
*E-mail
FAX

 

Motorcycle Information

*Year  
*Make  (Manufacturer)
*Model (Be Specific)
*CC'S         
 *Weight 

 

 What Type of Coverage?

*What Type of Policy are you looking for?

*Pick Limits of Liability and Physical Damage 

*Please Choose Deductible for Comp. & Coll. 

*Do you want optional Spousal Liability? 

*Do you want optional OBEL (Pedestrian)?

*Do you want Optional Medical Payments?

*Do You want Optional Roadside Assistance?

*Do You want optional Towing?

 

 

Underwriting & Discount Questions

Please answer the following questions so we can find you the lowest available rates!

*Marital Status?

*Do you have a Motorcycle License?
*Years of Motorcycle Experience?
*Is Motorcycle Garaged? 
*Major Tickets or Violations in the last 39 months?

*Driver Training or Safety Course Certificate?
Member of Motorcycle Rider Group?
Are You a Homeowner?
*Is the above Motorcycle Currently Insured ?  
If the above motorcycle is currently insured  
What is your current Motorcycle premium  ? 

 

 

Use this text box for any questions or comments you may have.

Please List any tickets, accidents or violations in last 39 months! 


 

Thank you for taking the time to fill out this worksheet. To provide you with an accurate quote we will confirm the information you have supplied us with  motor vehicle records and consumer reports which may include your credit and financial responsibility information. This information will be kept confidential and is used by insurance companies for rating  purposes only. By submitting this form you are authorizing us to access this information.

 

We appreciate the opportunity to review your insurance needs. As an Independent Insurance Agent it is our goal to provide you with the best coverage at the lowest price from a top quality company. We look forward to serving you in the near future. Please let us know what are the best ways to contact you

Home Phone  Work Phone Cell Phone 
Fax  E-mail   Regular Mail

 

 

Kenneth Veale

 

Ryde Insurance Agency

106 W Broadway

Port Jefferson, New York, 11777

                                                                                                                                                                      

E

E-mail: Rydemc@aol.com

Phone:631-476-0722

Fax: 631-476-1378

 

 

 


Ryde Insurance Agency
Copyright 1999 [Ryde Motorcycles]. All rights reserved.
Revised: February 05, 2010

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