Costen and Associations Insurance and Financial Planning Ltd. Friendly Personalize Service with a Choice
 
 

Motorcycle Quote

**Please Note: ALL fields in the following form are required in order to process your quote.

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

Owners Information:

**ALL fields in the following form are required in order to process your quote.

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

Operator's Information:

**ALL fields in the following form are required in order to process your quote.

Are you currently a member of any motorcycle association? If yes, which one?
Do all operators have a Class 6 licence?
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:

**ALL fields in the following form are required in order to process your quote.

Coverage Required:
Year: Make: Model: CC's:
Selling Price (including GST/fees):
Accessory Amount (including GST/fees):
VIN (if known):

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 (please check one):

Home phone:
Other phone:
E-mail:
Fax:

PLEASE NOTE: This is a quote only - an application form must be completed and signed in order to bind coverage. Thank you.

  
 
 
 
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