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Quotes

Motorcycle Insurance

Name:
Address:
City:
Province:
Postal Code: (X1Y 2Z3)
Phone Number: (123-456-7890)
Email Address: (xxx@yyyy.zzz)
Age:
License #
M2/M License Date: (dd/mm/yyyy)
Did you take a riders
training course?
  
Any tickets?   
Any claims in last 6 years?   
Please provide details regarding accidents and/or tickets in the space provided.
Years Continuously Insured:
Liability Limit:
Collision deductible amount:
Comprehensive deductible amount:
All perils deductible amount:
Specified perils deductible amount:
Year, make and model:
Value of bike:
Engine Displacement (CCs):
Modified or customized:   
Previous insurance company:
Do you belong to any Riders Associations or Clubs?   
Referred By:
 

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