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This is a quote request for motorcycle insurance in the state of South Dakota. There is no obligation to purchase insurance by filling out this page. Also, no insurance coverage can be bound by submiting this form. If coverage is later requested, an application for insurance will need to be signed and a down payment of premium made. Any rates given are subject to the companies final review and approval. Descriptions of coverages given below are only brief general statements about some of the coverages available.


Contact Information

  Name 
  Address 
  City, State ZIP 
  Phone 
  E-Mail 
  FAX 


Underwriting Questions

 Residency Status: Do you own a   
 house?   
 yes 
 no 
 Do you have prior experience   
 operating motorcycles?   
 yes 
 no 
  Years
 Do you currently have motorcycle   
 insurance?   
 yes 
 no 
Expiration Date
  
 Do you belong to a motorcycle   
 riders club?   
 yes 
 no 
Motorcycle Club
  


Driver Information

    Driver #1    Name  
   Birthdate    
      
  Sex    male 
female 
  Marital  
  Status  
single 
married 
    License #        SSN #   

    Driver #2    Name  
   Birthdate    
      
  Sex    male 
female 
  Marital  
  Status  
single 
married 
    License #        SSN #   


Traffic Violations

 List all minor violations (speeding, stop sign, etc.) for the last 3 
 years, and all major violations (DWI, reckless driving, etc.) for 
 last 5 years.  List the DRIVER, DATE, and TYPE OF VIOLATION. 


Accidents

 List all accidents which occurred in the last 3 years. List the 
 DRIVER, DATE, FAULT, AMOUNT, and a BRIEF DESCRIPTION. 


Motorcycle Information

Motorcycle #1 Year Make Model CCs Serial Number

Motorcycle #2 Year Make Model CCs Serial Number


Liability Coverages and Limits
click here for description

  Liability - Bodily Injury Limits 
  Liability - Guest Passenger Limits 
  Liability - Property Damage Limit 
  Medical Payments Limit 
  Uninsured Motorists Limits  (same as Bodily Injury limits)
  Underinsured Motorists Limits  (same as Bodily Injury limits)


Physical Damage Coverages
click here for description

  Motorcycle 1 Motorcycle 2
Comprehensive
Deductible
Collision
Deductible
Value of Custom
Equipment
$ $


Comments



When you are finished filling out this form, click on the "quote" button below to send the information.








Copyright 2005 Strait Insurance Agency, Inc. All rights reserved.


















































Liability Coverage - Pays for other people's injuries and damage to their property if you cause an accident while driving your vehicle. It protects your assets in the event you are held liable for damages to others.

     In this example for Bodiliy Injury limits:     $25,000 / $50,000
                                 $25,000 is the bodily injury limit for each person, and
                                 $50,000 is the bodily injury limit for each accident.


Guest Passenger - This optional liability coverage offers injury protection to anyone who might climb on the back of your bike.

Medical Payments - Pays for medical expenses incurred by you or your passengers while occupying an insured motorcycle.

Uninsured and Underinsured Motorists Coverage - Pays bodily injury claims for you if you are injured by a negligent uninsured motorist, hit-and-run vehicle, or a negligent driver without adequate insurance.

click here to return to Required Coverages and Limits





Other Than Collision (Comprehensive) - Pays for damage to your cycle caused by theft, fire, windstorm, hitting an animal, glass breakage and many other non-collision occurrences.

Collision - If your motorcycle collides with another vehicle or object, this coverage pays to repair your motorcycle.

Deductible - The portion of the loss you must pay yourself before the insurance coverage pays.

click here to return to Physical Damage Coverages




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