Tribute Insurance Brokers Inc.

ATTENTION KINGSWAY INSURED

If you have insurance with Kingsway, and wish to move your policy to our office, click here We will check your coverage and be sure you are getting the Best Rate and Maximum Discounts.

The following forms have been designed to ensure you receive the most accurate motorcycle insurance quote possible. Please make sure you accurately complete all required fields on each screen. Move between fields with mouse or tab key. When finished click the "Submit Information" button. We will contact you within the next 48 hours.

Full Name

Vehicle 1:
Year Make Model
CC's VIN # (optional)

Vehicle 2:
Year Make Model
CC's VIN # (optional)

Address Line 1
Address Line 2
City Province Postal Code
Residence: Own Rent Other

Garaged Address Line 1
Garaged Address Line 2
City Province Postal Code
Is vehicle kept in a: Locked garage Patio Car port Driveway

Date Of Birth:
Marital Status: Single Married
Do you have a valid Driver's License? Yes No
Do you have a motorcycle endorsement? Yes No
Number of Accidents (at fault) Number of Accidents (Not at fault) (within past 36 months)
Number of Tickets (Moving) Number of Tickets (Not moving) (within past 36 months)
Number of years street riding experience

Home Phone Number Work Phone Number
Fax Phone Number Pager Phone Number
E-Mail Address
How would you like us to respond to this quote? E-Mail Phone Fax Pager Postal Mail

Does your vehicle have an audible alarm? Yes No
Have you had insurance on this vehicle in the past 6 months? Yes No
If YES which company?
Do you have insurance on this vehicle now? Yes No
If so, which insurance company? Expiration Date
Have you successfully completed a safety course for motorcycle in the past 36 months? Yes No
Lienholder? Yes No
Do you belong to a motorcycle rider association? (AMA, GWRRA, HOG, etc.) Yes No
If so, which rider association?

What kind of coverage would you like?
Liability Only Liability and Comprehensive (includes Theft) Liability and Comprehensive + Collision

Optional Coverages:
Uninsured Motorist PIP (Personal Injury Protection) Medical Payments

Enter comments or questions here: