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13719 N. Nebraska Ave Suite 103 Tampa, FL 33613
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Jeca Resources & Services
Motorcycle Quote
Motorcycle Quote
Vehicle Information
Primary Motorcycle
Year
Make
Model
Drive to Work/School?
No
Yes
Is Motorcycle Leased?
Yes
No
Work/School Distance
Less than 5 Miles
5 Miles
10 Miles
15 Miles
20 Miles
30 Miles
Over 30 Miles
N/A
Collision Deductible
No Coverage
$100
$250
$500
$1000
Annual Mileage
5,000
7,500
10,000
12,500
15,000
20,000
30,000
40,000
50,000+
Comprehensive Deduct
No Coverage
$100
$250
$500
$1000
Do you have more than 2 motorcycles to insure?
No
Yes - 4 Total
Yes - 5 Total
Yes - 6 Total
Yes - 7 Total
Yes - 8+ Total
Submit
Motorcycle #2 (if necessary)
Year (M2)
Make (M2)
Model (M2)
Drive to Work/School? (M2)
No
Yes
Is Motorcycle Leased? (M2)
Yes
No
Work/School Distance (M2)
Less than 5 Miles
5 Miles
10 Miles
15 Miles
20 Miles
30 Miles
Over 30 Miles
N/A
Collision Deductible (M2)
No Coverage
$100
$250
$500
$1000
Annual Mileage (M2)
5,000
7,500
10,000
12,500
15,000
20,000
30,000
40,000
50,000+
Comprehensive Deduct (M2)
No Coverage
$100
$250
$500
$1000
Do you have more than 2 motorcycles to insure? (M2)
No
Yes - 4 Total
Yes - 5 Total
Yes - 6 Total
Yes - 7 Total
Yes - 8+ Total
Submit
Driver Information
Primary Operator
Primary Driver Name
Gender
Male
Female
N/A
Married?
Yes
No
Date of Birth
Status
Employed
Student
Retired
Other
Submit
Operator #2 (if necessary)
Operator 2 Name
Gender (O2)
Male
Female
N/A
Married? (O2)
Yes
No
Date of Birth (O2)
Status (O2)
Employed
Student
Retired
Other
Submit
Additional Information
First Name
Last Name
Address
City
Zipcode
State
Country
Email
Phone Number
Current or Prior Insurance Company
Continuous Coverage
3+ Years
2 Years
1 Year
6 Months
Under 6 months
Not Currently Insured
Policy Expires In
Not sure
A Few days
2 weeks
1 Month
2 Months
3 Months
3-6 Months
6+ Months
Claims in 3 Years
1
2
3
4+
None
Tickets in 3 Years
1
2
3
4
5
6+
None
Coverage Desired
Standard Coverage
Premium Coverage
State Minimum
When would you like this policy to start?
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