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St. Catharines
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Quote Requests
Motorcycle Insurance
Name:
Email Address:
Address:
City:
Province:
Postal Code:
Phone Number:
Age:
License #:
M1 License Date:
Date and time
M2 License Date:
Date and time
M License Date:
Date and time
Did you take a Riders Training Course:
Yes
No
Any Tickets:
Yes
No
Any claims in last 6 years:
Yes
No
What Coverage are you looking for:
All perils
Collision
Comprehensive
Specified perils
Liability Limit:
$100
$250
$500
$1,000
Collision Deductible amount:
$100
$250
$500
$1,000
Comprehensive Deductible amount:
$100
$250
$500
$1,000
Specified Perils Deductible amount:
$100
$250
$500
$1,000
Year, make and model:
Value of Bike:
Modified or Customized:
Yes
No
Previous Insurance Company:
Do you belong to any Riders Associations or Clubs:
Yes
No