Motorcycle Insurance Quote February 16, 2016by JWDavis Motorcycle Quote Step 1 of 2 50% Name* First Last Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Telephone Number*Email Address* Any cancellations for non-payment in the last 3 years?NoYesWhen should coverage start?* Date Format: YYYY slash MM slash DD Driver(s) InformationDate of Birth:* Date Format: YYYY slash MM slash DD Years holding motorcycle license in Canada:*DATE OF LICENSE:*M1 (MM/YYYY)M2 (MM/YYYY)M (MM/YYYY)Sex:*MaleFemaleMarital status:*MarriedSingleCommon-lawWidowMotorcycle training course in the last 3 years?*YesNoDate of course:* Date Format: YYYY slash MM slash DD Retired:*YesNoMinor traffic convictions in the last 3 years:*0123more than 3Major traffic convictions in the last 3 years:*0123more than 3 (careless or impaired driving, refusing breathalyzer, etc.)Do you currently have motorcycle insurance?NoYesName of previous insurance company*Have any of above drivers had their licenses suspended or lapsed in the past 6 years?*NoYesHave any of the drivers above had accidents or claims in the past 10 years?*NoYes Claims InformationClaims #1N/A #1At-fault accidentNot at-fault accidentPartial at-fault accidentWindshield/ vadalism/ theftDate #1 Date Format: YYYY slash MM slash DD Claim #2N/A #2At-fault accidentNot at-fault accidentPartial at-fault accidentWindshield/ vadalism/ theftDate #2 Date Format: YYYY slash MM slash DD Claim #3N/A #3At-fault accidentNot at-fault accidentPartial at-fault accidentWindshield/ vadalism/ theftDate #3 Date Format: YYYY slash MM slash DD Motorcycle InformationBike #1 make:*Bike #2 make:Year Bike#1:*Year Bike #2:Model Bike #1:*Model Bike #2:CC Bike #1:*CC Bike #2:Turbo Engine Bike #1:*NoYesTurbo Engine Bike #2:NoYesValue Bike #1:*Value Bike #2:Use Bike #1:*Commute OnlyPleasure OnlyTouringUse Bike #2:Commute OnlyPleasure OnlyTouringKM driven one way to work Bike #1 use:*KM driven one way to work Bike #2 use:Kilometers driven per year Bike #1:*0 - 50005001 - 1000010001 - 1500015001 - 2000020001 - 25000over 25000Kilometers driven per year Bike #2:0 - 50005001 - 1000010001 - 1500015001 - 2000020001 - 25000over 25000When was the Bike #1 purchased? Date Format: YYYY dash MM dash DD When was the Bike #2 purchased? Date Format: YYYY slash MM slash DD Coverage RequiredLiability Bike #1:*Please Select$1,000,000$2,000,000Liability Bike #2:$1,000,000$2,000,000Income Replacement Bike #1:*Please SelectStandard$600$800$1,000Income Replacement Bike #2:Standard$600$800$1,000Medical Rehabilitation Bike #1:*Please SelectStandardBuy-BackEnhancementMedical Rehabilitation Bike #2:Please SelectStandardBuy-BackEnhancementMedical Rehabilitation Bike #1:*Please SelectStandardBuy-BackEnhancementMedical Rehabilitation Bike #2:Please SelectStandardBuy-BackEnhancementCaregiver Bike #1:*Please SelectStandardBuy-BackCaregiver Bike #2:Please SelectStandardBuy-BackHousekeeping & Home Maintenance Bike #1:*Please SelectStandardBuy-BackHousekeeping & Home Maintenance Bike #2:Please SelectStandardBuy-BackDependant Care Bike #1:*Please SelectStandardEnhancementDependant Care Bike #2:StandardEnhancementDeath / Funeral Bike #1:*Please SelectStandardEnhancementDeath / Funeral Bike #2:Please SelectStandardEnhancementIndexation Bike #1:*Please SelectStandardEnhancementIndexation Bike #2:Please SelectStandardEnhancementCollision deductible Bike #1:*Please Select$0$500$1,000Collision deductible Bike #2:Please select$0$500$1,000Comprehensive Coverage Deductible Bike #1:*Please Select$0$500$1000$1,500Comprehensive Coverage Deductible Bike #2:Please select$0$500$1000$1,500Is the motorcycle Modified/Customized?NoYesDo you belong to any Riders Associations or Clubs?NoYesAdditional InformationNoneWhat is the name of the individual or organisation that referred J. W. Davis?