Toll Free: 1-800-465-5052 ext 125 Local: 416-461-6474 ext 125 Fax: 416-461-8497

Murtaugh Smith Financial

Motorcycle and Scooter Insurance Quotes for Ontario

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PLEASE CALL IF YOU'D PREFER THE QUOTE BY PHONE!

Don't be afraid to ask ANY questions!
We are the Motorcycle and Scooter Insurance Experts

416-461-6474 (extension 125) or 1-800-465-5052 (extension 125)

Rates quoted will be as accurate as possible, based on the facts provided to us. Rates are for the term of one year and are subject to any applicable interest charges relating to payment plans available.

Motorcycles / Scooters OVER FIFTEEN years old - 'Liability only' available

Ontario Motorcycle & Scooter Insurance Quote Request Form

Please complete all boxes
(Complies with the requirements of the Personal Information
Protection and Electronic Documents Act, 2004)

Operator Information

Full Name:
Address:
City (in Ontario):
Postal Code:
Phone Number and Area Code:
Email Address:	* Replies to Hotmail, Sympatico and AOL users may be found in your JUNK folder - please choose Mark as Safe replies from robina@259danforth.com
Fax Number:
Date of Birth:	(MM/DD/YYYY)
Gender:	Male Female
Marital Status:
Date Insurance Required:

Licence Information

Current "M Licence" Level:
Safety Training Course:
Date "M Licence" obtained (enter VOID if not applicable):	(MM/YY)
Date "M2 Licence" obtained (enter VOID if not applicable):	(MM/DD/YYYY)
Date "M1 Licence" obtained (enter VOID if not applicable): Accurate responses to your licence date(s) will assist in us supplying correct quotes	(MM/DD/YYYY)
Your Ontario auto/motorcycle licence number:

Motorcycle Insurance History

Do you currently hold Motorcycle Insurance:	Yes No
Have you held a minimum of 12 continuous months of motorcycle or scooter insurance entirely within the last three years?	Yes No
Have you held a minimum of 36 months of motorcycle or scooter insurance entirely within the last FIVE years? ( OR 6 month periods: April to November yearly for SIX prior years accepted )	Yes No
Do you have any moving violation convictions (tickets) in the last 3 years?	Yes No
If "no", please enter "none" If "yes", please explain (dates, violations, etc.):
Have there been any claims/accidents on motorcycle or auto in last 6 years?	Yes No
If "no", please enter "none" If "yes", please explain (dates, violations, etc.):
Please list any other licenced motorcyclists in your household with name, date of birth, licence level dates / Training Course/ insurance/ tickets/ motorcycle or scooter accidents

Motorcycle / Scooter Information

Motorcycles / Scooters OVER FIFTEEN years old - 'Liability only' available

Quote Options:

	Bike #1	Bike #2
VIN/Serial Number if known (this may be up to 17 characters)
Year, Make and Model (full description if possible):
Is it a Sportbike? We only insure earlier models. (click here for complete list)	Yes No	Yes No
How many C.C.s:
Purchase Date:
Current Actual Cash Value (see Guide To Values):
Waiver of Depreciation? (available for up to two years on NEW motorcycles only) :	Yes No	Yes No
Motorcycle has H-D Security system; Gorilla; Viper; Merlin; Scorpio; Armed Guard or Auto Watch system:	Yes No	Yes No
Intended Use Of Bike:

Insurance Coverages

Click Here For Explanations

Third Party Liability: (we strongly recommend $1 million level)
Collision:
Collision:
Comprehensive / Specified Perils:
Comprehensive / Specified Perils:
Group Discount Rate? (see approved group list):
Policy Payment Arrangement:
How did you find us?:
Your Additional Comments: (Want auto/home/business insurance quotes? - please supply policy renewal dates & current insurance companies)

Please check that you have supplied all information requested and correctly chosen available options. You can clear the form and start again if unsure. We'll provide a speedy quote! The Program staff looks forward to serving you.
Please click once only

A service of:

Murtaugh Smith Financial
259 Danforth Avenue
Toronto, Ontario, Canada M4K 1N2