Motorcycle Quote Form

Registered Vehicle Owner
This will be the policy owner and must be the registered owner of the motorcycle to be insured.
Registered Vehicle Owner's Name*
First Name Last Name
Phone Number*
Optional Secondary Phone Number
Email*
Optional Secondary Email
Address*
Address the vehicle is registered to.

Street Address City Province
Postal Code*
How did you hear about us?*
Effective Date*
Requested Policy Start Date
MM slash DD slash YYYY

Motorcycle #1 Details
How many motorcycles would you like quoted?*
Only motorcycles, we have a separate form for private passenger automobiles.
Year of Vehicle*
Make & Model & CC's*
Be as specific as possible for most accurate quote and mention how many CC's.
VIN
Providing a VIN is not mandatory but will increase accuracy of the quote.
Condition When Bought*
What status was the vehicle when you purchased it?
Year Purchased?*
When did you purchase the motorcycle?
Purchase Price?*
What was your cost to purchase the motorcycle?
Annual KM's Driven*
How many KM's do you expect to put on the vehicle over the course of the next year?
Is vehicle currently financed or leased?*
Coverage Required:
If financed or leased full coverage is mandatory.
Any Pre-Existing Damage on the Vehicle?
If any pre-existing damage please be as detailed as possible explaining the damage.
- No Damage

Motorcycle #2 Details
Year of Vehicle*
Make & Model & CC's*
Be as specific as possible for most accurate quote and mention how many CC's.
VIN
Providing a VIN is not mandatory but will increase accuracy of the quote.
Condition When Bought*
What status was the vehicle when you purchased it?
Year Purchased?*
When did you purchase the motorcycle?
Purchase Price?*
What was your cost to purchase the motorcycle?
Annual KM's Driven*
How many KM's do you expect to put on the vehicle over the course of the next year?
Is vehicle currently financed or leased?*
Coverage Required:
If financed or leased full coverage is mandatory.
Any Pre-Existing Damage on the Vehicle?
If any pre-existing damage please be as detailed as possible explaining the damage.
- No Damage

Motorcycle #3 Details
Year of Vehicle*
Make & Model & CC's*
Be as specific as possible for most accurate quote and mention how many CC's.
VIN
Providing a VIN is not mandatory but will increase accuracy of the quote.
Condition When Bought*
What status was the vehicle when you purchased it?
Year Purchased?*
When did you purchase the motorcycle?
Purchase Price?*
What was your cost to purchase the motorcycle?
Annual KM's Driven*
How many KM's do you expect to put on the vehicle over the course of the next year?
Is vehicle currently financed or leased?*
Coverage Required:
If financed or leased full coverage is mandatory.
Any Pre-Existing Damage on the Vehicle?
If any pre-existing damage please be as detailed as possible explaining the damage.
- No Damage

Motorcycle #4 Details
Year of Vehicle*
Make & Model & CC's*
Be as specific as possible for most accurate quote and mention how many CC's.
VIN
Providing a VIN is not mandatory but will increase accuracy of the quote.
Condition When Bought*
What status was the vehicle when you purchased it?
Year Purchased?*
When did you purchase the motorcycle?
Purchase Price?*
What was your cost to purchase the motorcycle?
Annual KM's Driven*
How many KM's do you expect to put on the vehicle over the course of the next year?
Is vehicle currently financed or leased?*
Coverage Required:
If financed or leased full coverage is mandatory.
Any Pre-Existing Damage on the Vehicle?
If any pre-existing damage please be as detailed as possible explaining the damage.
- No Damage

Driver #1 Details
Including yourself how many motorcycle riders in the household?*
Driver # 1 Name*
First Name Last Name
Gender*
Driver # 1 Date of Birth*
MM slash DD slash YYYY
Driver # 1 Marital Status*
Driver # 1 Occupation:
Certain occupations qualify for preferred rates, be as detailed as possible.
Driver # 1 Current License Held*
Driver # 1 Year License Issued*
What year did you receive this license?
Driver # 1 Ontario Driver's License Number*
Have you completed motorcycle driver training?*
How many years of continuous insurance history on a motorcycle?*
How long have you had motorcycle insurance with NO gaps in your coverage?
How many tickets in past 3 years?*
Parking tickets don't count.
How many accidents in past 6 years?*
How many drivers license suspensions in past 3 years?*
How many cancellations by the insurance company in past 3 years for non-payment?*

Driver #2 Details
Driver # 2 Name*
First Name Last Name
Gender*
Driver # 2 Date of Birth*
MM slash DD slash YYYY
Driver # 2 Marital Status*
Driver # 2 Occupation:
Certain occupations qualify for preferred rates, be as detailed as possible.
Driver # 2 Current License Held*
Driver # 2 Year License Issued*
What year did you receive this license?
Have you completed motorcycle driver training?*
How many years of continuous insurance history on a motorcycle?*
How long have you had motorcycle insurance with NO gaps in your coverage?
Driver # 2 Ontario Driver's License Number*
How many tickets in past 3 years?*
Parking tickets don't count.
How many accidents in past 6 years?*
How many drivers license suspensions in past 3 years?*
How many cancellations by the insurance company in past 3 years for non-payment?*

Driver #3 Details
Driver # 3 Name*
First Name Last Name
Gender*
Driver # 3 Date of Birth*
MM slash DD slash YYYY
Driver # 3 Marital Status*
Driver # 3 Occupation:
Certain occupations qualify for preferred rates, be as detailed as possible.
Driver # 3 Current License Held*
Driver # 3 Year License Issued*
What year did you receive this license?
Have you completed motorcycle driver training?*
How many years of continuous insurance history on a motorcycle?*
How long have you had motorcycle insurance with NO gaps in your coverage?
Driver # 3 Ontario Driver's License Number*
How many tickets in past 3 years?*
Parking tickets don't count.
How many accidents in past 6 years?*
How many drivers license suspensions in past 3 years?*
How many cancellations by the insurance company in past 3 years for non-payment?*

Driver #4 Details
Driver # 4 Name*
First Name Last Name
Gender*
Driver # 4 Date of Birth*
MM slash DD slash YYYY
Driver # 4 Marital Status*
Driver # 4 Occupation:
Certain occupations qualify for preferred rates, be as detailed as possible.
Driver # 4 Current License Held*
Driver # 4 Year License Issued*
What year did you receive this license?
Have you completed motorcycle driver training?*
How many years of continuous insurance history on a motorcycle?*
How long have you had motorcycle insurance with NO gaps in your coverage?
Driver # 4 Ontario Driver's License Number*
How many tickets in past 3 years?*
Parking tickets don't count.
How many accidents in past 6 years?*
How many drivers license suspensions in past 3 years?*
How many cancellations by the insurance company in past 3 years for non-payment?*

Driver #5 Details
Driver # 5 Name*
First Name Last Name
Gender*
Driver # 5 Date of Birth*
MM slash DD slash YYYY
Driver # 5 Marital Status*
Driver # 5 Occupation:
Certain occupations qualify for preferred rates, be as detailed as possible.
Driver # 5 Current License Held*
Driver # 5 Year License Issued*
What year did you receive the license?
Have you completed motorcycle driver training?*
How many years of continuous insurance history on a motorcycle?*
How long have you had motorcycle insurance with NO gaps in your coverage?
Driver # 5 Ontario Driver's License Number*
How many tickets in past 3 years?*
Parking tickets don't count.
How many accidents in past 6 years?*
How many drivers license suspensions in past 3 years?*
How many cancellations by the insurance company in past 3 years for non-payment?*

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Picture & Document Upload
Optional feature, upload picture of vehicle, ownership, driver's license, etc.
Drop files here or

Max. file size: 50 MB.
Comments
Include any additional comments.

Registered Vehicle Owner

Motorcycle #1 Details

Motorcycle #2 Details

Motorcycle #3 Details

Motorcycle #4 Details

Driver #1 Details

Driver #2 Details

Driver #3 Details

Driver #4 Details

Driver #5 Details

Upload / Comments