Erb and Erb Insurance Brokers Ltd. Your Motorcycle Insurance Specialists

Motorcycle/ATV/Snowmobile Quote Form

Thank you for coming to our recreational vehicle quote page. Please take the time to complete the form below and we'll provide you a no obligation quote.

Please refer to our detailed privacy page regarding your personal information: http://erb-erb.com/privacy-policy.php

Name:

Address:

Birth Date:

Year: Month: Day:

Year, Make, Model, CC's of the Bike, ATV, Snowmobile:

Coverage Requested:

Rider Training Courses Taken:

Total Years Licensed:

Dates You Obtained Your M1, M2 and if you went through Graduated Licensing:

Any Prior Bike Insurance in the Last 3 Years?:

N0 Yes

If the above applies, how long has your most recent policy been in force?:

Current Class of Bike License:

M1 M2 Full M

Any Tickets Receivedin the Last 3 Years?:

N0 Yes

If Yes above - please elaborate on the types of tickets you have received and roughly when you got them:

Any Accidents/claims in the Last 3 Years?:

N0 Yes

If so - please elaborate on the type of claim/accident, when it occurred, and whether or not you were deemed to be be at fault:

Has any insurance company cancelled you insurance in the Last 3 Years?:

N0 Yes

If so - please elaborate as to when this was, and why it was cancelled:

Any other riders living in your home not already insured? Id so, please complete this questionnaire for them as well?:

N0 Yes

Please indicate use of the bike, i.e.: Pleasure riding only, commuting (If commuting please indicate how many KM's you commute one-way), show bike only, racing, etc.:

Method of contact:

E-mail Phone

Phone Number:

E-mail Address:

Other Comments or Questions:

What our Clients are Saying...

“Dave Lagonia has been servicing our account for over five years. He has provided us with excellent service, clear and concise answers to our questions on a timely basis and always with a pleasant, professional attitude. He has been able to negotiate our premiums annually all to the benefit of our company. We sincerely appreciate his dedication and honesty in this industry.”

Rhonda A., Controller at Reliable Liftx

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