Motorcycle Insurance Name Address City Province Postal Code Phone Number Email Address Age License # M1 License Date: M2 License Date: M License Date: Did you take a Riders Training Course: YesNo Any Tickets: YesNo Any claims in last 6 years: YesNo Coverage Preferred: All perilsCollisionComprehensiveSpecified Perils Liability Limit: $100$250$500$1000 Collision Deductible amount: $100$250$500$1000 Comprehensive Deductible amount: $100$250$500$1000 Specified Perils Deductible amount: $100$250$500$1000 Year, make and model: Value of Bike: Modified or Customized: YesNo Previous Insurance Company: Do you belong to any Riders Associations or Clubs: YesNo
