Collector Car Insurance

(800) 787-7637

Classic Motorcycle Insurance Quote

Attention: in order to insure your motorcycle, you must also own a collector car.
*  fields are required.
Personal Information
First and Last Name: *
Address: *
City: *
State: *
Zip: *
Garaging County: *
Day Time Phone #: *
Evening Phone #:
Fax #:
E-mail Address: *
Drivers Lic. #: *
Date of Birth: *
Spouse's Date of Birth:
Own Home (Yes/No) *
Liability Limits for Daily Vehicles: *
Any Traffic Violations or accidents?
If yes, please provide with violation type and conviction date.
Are you currently Insured?
If Yes, when does your current policy expire?
If Yes, who are you currently insured with?
What are your limits of liabity and uninsured motorist primary policy?
BI-PD Limits on Primary Auto Policy
How long have you had a motorcycle license?
Have you taken a certified cycle safety class?
Does the vehicle have an alarm?
What is your Marital Status?
Hom many miles a year do you ride?
Are you a member of these associations?
Motorcyle Information
Motorcycle #1
Year: *
Make: *
Model: *
Value: *
Engine Size (cc): *
VIN#:
Motorcycle #2
Year:
Make:
Model:
Value:
Engine Size (cc):
VIN#:
Additional Driver Info
Additional Driver #1
Name of Additional Driver:
Date of Birth:
Accidents:
Moving Violations:
Additional Driver #2
Name of Additional Driver:
Date of Birth:
Accidents:
Moving Violations:
Additional Driver #3
Name of Additional Driver:
Date of Birth:
Accidents:
Moving Violations:
 




Contact Us

Collector Car Insurance

8422 Union Chapel Road • Fort Wayne, IN 46845
(800) 787-7637 • 260-627-3355 • Send Us An Email
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United States of America