We appreciate the opportunity to review your insurance needs. Privacy is your right and our concern. All information you provide us will be use by us and the insurance companies we represent for rating purposes only and will not be shared with any one else. We offer three ways to get an insurance quote:

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Web Form

Insured's Information

                       Please fill in all fields

Last Name 


First Name  


Middle Initial  


Street Address 


City or Town  



Zip Code    
Date of Birth       

Social Security#  

Driver License #      
Contact Phone     

Motorcycle Information


Unit 1

Unit 2 (optional)

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




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 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


Your Marital Status


D0 you have a Motorcycle License?  
Years of 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?  
Are You a Homeowner?  
Do you need a Lien holder listed on Policy  
Is the above Motorcycle Currently Insured?  
 If yes, who  are you insured by?  
What is your current Motorcycle premium?   




Use text box for any questions or comments.

Please list all tickets and violations in last 39 months

Do you want to list an additional operater?





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 your DMV records and your consumer reports which include your credit and financial responsibility information to obtain an insurance quote for you. This information will be kept confidential and is used by us and the insurance companies we represent for rating  purposes only. By submitting this form you are authorizing us to access your information and provide you with a quote.


Kenneth Veale

Ryde Insurance Agency

Ryde Insurance Agency

106 W Broadway

Port Jefferson, New York, 11777






Fax: 631-476-1378