DEALER INSURANCE QUOTE
We appreciate the opportunity to offer an insurance quote to your customer. We realize getting your customer a good rate can help close a difficult deal. We offer three ways to get an insurance quote: Use our web based dealer insurance quote form below, use our printable fax based insurance quote form or call us at 631-476-0722 for a quote over the phone. Ask about our dealer referral program.
 

Dealers - Getting An Insurance Quote is Easy!


Web Dealer Quote Form: For an accurate quote, please fill in all fields of this six (6) part form. You can easily navigate this form using the Tab key.

 

#1-Dealer Information

 

Dealer Name  

 

Salesman Name  

 

Dealer Phone  

 

Dealer FAX  

 

Dealer E-mail  

 

      How did you find Us?  

 


 

#2-Customer's - Insured's Information

            

Last Name 

 

First Name  

 

Middle Initial  

 

Street Address 

  

City or Town  

 

State  

 
Zip Code    
Date of Birth       
Occupation    

Social Security#  

  
Driver License #      
Contact Phone     
 
 
 

#3-Motorcycle Information

 

Unit 1

Unit 2 (optional)

Year   Year  
Make   Make  
Model   Model  
CC'S   CC'S  
Vin #    Vin #  
$ Amt    $Amt

 

 

 

#4-Type of Coverage Desired

 

      What Type of Policy are you looking for?  

Pick Limits of Liability and Physical Damage 

Please Choose Deductible for Comp. & Coll. 

Do you want Spousal Liability? 

Do you want optional OBEL (Pedestrian)?  

Do you want Optional Medical Payments?  

Do You want Roadside Assistance?  

Do You want Towing?  

     


 

#5-Underwriting & Discount Questions

 

Insured's Marital Status

 

Does insured have a Motorcycle License?  
Insured's Motorcycle Experience?  
Is Motorcycle Kept in locked Garaged?   
Major Tickets/Violations in the last 39 months?

 

Driver Training or Safety Course Certificate?  
Member of Motorcycle Rider Group?  
Is insured a Homeowner?  
Do you need a Lien holder listed on Policy  

 


 

 

#6-Use text box for any questions or comments.

Please list all tickets and violations in last 39 months

Please list lien holder if applicable.

Do you want to list an additional operator on policy?

 

 


 

 

It is our goal to provide you with the best coverage at the lowest price from one of top quality insurance companies we represent. We look forward to serving you in the near future. 

How should we contact you? Phone  Fax  E-mail  Regular Mail      
 

Thank you for taking the time to fill out this worksheet. We will use the information you supplied along with customers DMV records and consumer reports which may include the insured's credit and financial responsibility information to obtain an insurance quote for your customer. This information will be kept confidential and is used by us and the insurance companies we represent for rating  purposes only and will not be shared with anyone else. By submitting this form you and the customer you represent are authorizing us to access this information and provide you with a quote.

 

 
Kenneth Veale
 

Ryde Insurance Agency

Ryde Insurance Agency

106 W Broadway

Port Jefferson, New York, 11777

 

 

E-mail: Rydemc@aol.com

E-mail: Ryde Insurance

Phone:631-476-0722

Fax: 631-476-1378

 

 

 




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