Get A Motorcycle/ATV Quote - The Roots Insurance

Effective Date of Coverage

First Name

Last Name

Email

Phone Number

Mailing Address

City

State/Province

Zip/Postal

Insured Moved in the last 60 days?

Prior Mailing Address

City

State/Province

Zip/Postal

Policy Type:

Number of Vehicles:

Vehicle #1

Vehicle Type:

Is Motorcycle a trike?

VIN:

CC Size:

Purchase year:

Anti-lock brakes?

Garaging Zip Code

Annual Miles Ridden:

Vehicle Use: Vehicle Use:

Primary Use: Primary Use:

Modified frame, nitrous oxide or turbo/supercharger?

LoJack Device installed on this vehicle?

BI/PD Limits:

Medical Payments (Medical Payments Coverage pays for medical expenses for the named insured and resident relatives of the named insured who are riding the insured vehicle and injured as a result of an accident. The limit applies to each covered and injured person. Coverage is only extended when no other motor vehicle insurance coverage applies.)

Comprehensive Deductible:

Collision Deductible:

Would you like Roadside/Trip Interruption:

Carrier Contents (Carried Contents coverage will pay for owned personal property (such as hunting gear or camping gear) that are damaged, destroyed or stolen while using the insured vehicle:

Accessory Coverage (Coverage provides physical damage protection to equipment, devices, accessories, enhancements, and changes, other than those which are original manufacturer installed, which are permanently installed or attached, and alter the appearance or performance of the vehicle):

$

Vehicle #2

Vehicle Type:

Is Motorcycle a trike?

VIN:

CC Size:

Purchase year:

Anti-lock brakes?

Garaging Zip Code

Annual Miles Ridden:

Vehicle Use: Vehicle Use:

Primary Use: Primary Use:

Modified frame, nitrous oxide or turbo/supercharger?

LoJack Device installed on this vehicle?

BI/PD Limits:

Medical Payments (Medical Payments Coverage pays for medical expenses for the named insured and resident relatives of the named insured who are riding the insured vehicle and injured as a result of an accident. The limit applies to each covered and injured person. Coverage is only extended when no other motor vehicle insurance coverage applies.)

Comprehensive Deductible:

Collision Deductible:

Would you like Roadside/Trip Interruption:

Carrier Contents (Carried Contents coverage will pay for owned personal property (such as hunting gear or camping gear) that are damaged, destroyed or stolen while using the insured vehicle:

Accessory Coverage (Coverage provides physical damage protection to equipment, devices, accessories, enhancements, and changes, other than those which are original manufacturer installed, which are permanently installed or attached, and alter the appearance or performance of the vehicle):

$

Vehicle #3

Vehicle Type:

Is Motorcycle a trike?

VIN:

CC Size:

Purchase year:

Anti-lock brakes?

Garaging Zip Code

Annual Miles Ridden:

Vehicle Use: Vehicle Use:

Primary Use: Primary Use:

Modified frame, nitrous oxide or turbo/supercharger?

LoJack Device installed on this vehicle?

BI/PD Limits:

Medical Payments (Medical Payments Coverage pays for medical expenses for the named insured and resident relatives of the named insured who are riding the insured vehicle and injured as a result of an accident. The limit applies to each covered and injured person. Coverage is only extended when no other motor vehicle insurance coverage applies.)

Comprehensive Deductible:

Collision Deductible:

Would you like Roadside/Trip Interruption:

Carrier Contents (Carried Contents coverage will pay for owned personal property (such as hunting gear or camping gear) that are damaged, destroyed or stolen while using the insured vehicle:

Accessory Coverage (Coverage provides physical damage protection to equipment, devices, accessories, enhancements, and changes, other than those which are original manufacturer installed, which are permanently installed or attached, and alter the appearance or performance of the vehicle):

$

Number of Drivers:

Driver #1

First Name:

Last Name

Date of Birth:

Gender:

Marital Status:

Drivers License Status:

Highest Level of Education:

MC Endorsement:

Approved Safety Course Completion:

Years riding experience:

How often do you ride during the riding season:

Enter all motor vehicle (auto, motorcycle, ATV, etc) accidents, tickets and comprehensive claims that occurred in the last 35 months for each operator.

Have you had motorcycle liability insurance in the last 12 months?

Prior motorcycle insurance carrier:

Prior policy term expiration date:

Primary Residence: Primary Residence:

Driver #2

First Name:

Last Name

Date of Birth:

Gender:

Marital Status:

Drivers License Status:

Highest Level of Education:

MC Endorsement:

Approved Safety Course Completion:

Years riding experience:

How often do you ride during the riding season:

Enter all motor vehicle (auto, motorcycle, ATV, etc) accidents, tickets and comprehensive claims that occurred in the last 35 months for each operator.

Have you had motorcycle liability insurance in the last 12 months?

Prior motorcycle insurance carrier:

Prior policy term expiration date:

Primary Residence: Primary Residence:

Driver #3

First Name:

Last Name

Date of Birth:

Gender:

Marital Status:

Drivers License Status:

Highest Level of Education:

MC Endorsement:

Approved Safety Course Completion:

Years riding experience:

How often do you ride during the riding season:

Enter all motor vehicle (auto, motorcycle, ATV, etc) accidents, tickets and comprehensive claims that occurred in the last 35 months for each operator.

Have you had motorcycle liability insurance in the last 12 months?

Prior motorcycle insurance carrier:

Prior policy term expiration date:

Primary Residence: Primary Residence:

Signature

I warrant the above to be true and understand the insurance contract will be considered based on my warranty.

Electronic Signature

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