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Motorcycle Quote

Referred By:
Owner Name:
Operator #1:
Date of Birth:
Operator #2:
Date of Birth:

Owner’s Information:

Address
City
Province
Postal Code
Home Phone:
Other Phone:
Fax:
Email Address:

Operator’s Information:

Are you currently a member of any motorcycle association? If yes, which one?
Do all operators have a Class 6 license?
Number of years licenced:
Do all operators have motorcycle driver’s training:
Have any operators had prior motorcycle insurance:
Number of years:

Please list for all operators:

Tickets/convictions in the past 3 years:
Accidents in the past 6 years:
Licence suspensions in the past 5 years:

Motorcycle Information:

Coverage required:
Year:
Make:
Model:
CC’s:
Selling Price (including GST/fees):
Accessory Amount (including GST/fees):
VIN (if known):
Dealer Name:
Dealer Contact:
Dealer Fax:
Dealer Phone:
Preferred method of contact:

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