K & K Brokerage: Motorcycle Quote Sheet

This form contains detailed information to help us fill your insurance needs. If you prefer to use our simple form, just click the link at the bottom of your screen.

All info you provide is strictly confidential, to enable us to serve you better, and will not be released to anyone else.

Proper liability limits protect you and your family from the hardships a lawsuit could bring as a result of a serious accident.

Personal Info:

Last Name

First Name

Address

City


State

Zip

Driver's License No.

Age

Marital Status
Single Married Divorced

Telephone No.

Best time to call you

 

Friends do not let friends ride without the proper insurance. Let K&K be a friend and suggest various coverage options.

Driver Info:

Did you have any tickets or accidents within the last three years?
Yes No

Do you have insurance on any bike currently? Or within the last five months?
Yes No

If yes, carrier name:

Have you ever taken a defensive driving course that you have a certificate for within the last three years?
Yes No

What type of coverage are you interested in?

Liability Comprehensive Collision

Do you have a motorcycle license or permit?
Yes No

About your vehicle:

Year

Make

Model

CC Size

Coverage Needed

Sport Bikes Provide Value of Bike

Comments or questions?

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3195 Richmond Road, Staten Island, NY 10306
718-987-1515 / fax 718-987-3698

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