Motorcycle Quote Sheet "*" indicates required fields Step 1 of 7 14% Can I start with getting your first and last name please?* First Last How did you hear about us? (Lead Source)*Google/Search EngineFriendFamilySocial MediaOtherDo you mind providing their name so we can match you with their agent?Other:Is there a writing agent you are already working with?- None -Tim HarrellLindsay HarrisDavid AllenBryan BatchelorAre you currently insured?* Yes No When do you need your insurance to start?* MM slash DD slash YYYY (Effective Date) "Now to ask a few questions about you and the other drivers..."Current Address* Street Address City State / Province / Region ZIP / Postal Code How long have you lived at the address above? More than 3 years Less than 3 years Previous Address* Street Address City State / Province / Region ZIP / Postal Code Driver's License Number*What is your Date of Birth?* MM slash DD slash YYYY Years of Riding Experince*Do you have a Motorcycle Endorsement?* Yes No Did you take a Rider Course?* Yes No What is your job title and industry or What kind of work do you do?"Some companies use this as a rating factor especially on the auto quote which we'll get to in a minute"What is your Marital Status?* Single Married Domestic Partner Divorced/Separated Widowed What is your spouse's name (or partner's)?* First Last Partner/Spouse - Driver's License Number*Partner/Spouse - Date of Birth* MM slash DD slash YYYY Years of Riding Experince*Do they have a Motorcycle Endorsement?* Yes No Did they take a Rider Course?* Yes No Partner/Spouse - Job Title/IndustryAdd Additional Driver? Yes No Additional DriverRelationshipDriver's License NumberDate of Birth MM slash DD slash YYYY Years of Riding ExperinceDo they have a Motorcycle Endorsement? Yes No Did they take a Rider Course? Yes No Add Additional Driver? Yes No Additional DriverRelationshipDriver's License NumberDate of Birth MM slash DD slash YYYY Years of Riding ExperinceDo they have a Motorcycle Endorsement? Yes No Did they take a Rider Course? Yes No Add Additional Driver? Yes No Additional DriverRelationshipDriver's License NumberDate of Birth MM slash DD slash YYYY Years of Riding ExperinceDo they have a Motorcycle Endorsement? Yes No Did they take a Rider Course? Yes No Add Additional Driver? Yes No Additional DriverRelationshipDriver's License NumberDate of Birth MM slash DD slash YYYY Years of Riding ExperinceDo they have a Motorcycle Endorsement? Yes No Did they take a Rider Course? Yes No Coverage Questions **SKIP if uploading current declarations page***Upload Declarations Page on Step 6Bodily Injury Limits30,000/60,00050,000/100,000100,000/100,000100,000/300,000300,000/300,000250,000/500,000500,000/500,000500,000/1,000,0001,000,000/1,000,0001,000,000/2,000,000Property Damage25,00050,000100,000250,000300,000500,000750,0001,000,000Medical Payments- None -$1,000$2,000$5,000$10,000$25,000$50,000$75,000$100,000Collision Deductible- None -$1000$500$250$100$0Comprehensive Deductible- None -$1000$500$250$100$0Towing- None -$50$100 "Now tell us about your motorcycle(s)..." **SKIP if uploading declarations page**Upload Declarations Page on Step 6YearMakeModelVINFull or Liability Liability Only Full Coverage Add Additional Vehicle? Yes No YearMakeModelVINFull or Liability Liability Only Full Coverage Add Additional Vehicle? Yes No YearMakeModelVINFull or Liability Liability Only Full Coverage Add Additional Vehicle? Yes No YearMakeModelVINFull or Liability Liability Only Full Coverage Add Additional Vehicle? Yes No YearMakeModelVINFull or Liability Liability Only Full Coverage "Just some final things..."Email "What's the best email address for us to send the proposal once we've done our research with our multiple companies?"Phone"Do you mind if we text you once we have the quotes completed to let you know to look at your email?"Preferred Way of Contact Phone Call Email Please Upload Any Significant Documents (i.e. current declarations pages, driver's license, etc.) Drop files here or Select files Max. file size: 98 MB. Notes(Anything else we should know?) **OPTIONAL - Customer Service Questions**OPTIONAL -What's prompting you to look at your insurance? (SKIP if this is purchasing) (We're looking for pain points with their current policy - are they looking for a lower price, did they experience bad service, poor claims experience?)**OPTIONAL - What did you like or dislike most about your current agent/company?"We want to know what to do or NOT to do to keep you as a customer for life"
