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OFFICIAL HARLEY DAVIDSON INSURANCE BROKER
Please bookmark this page and read the notes and questions below carefully before replying

My job at J.D. Smith is to save you money and arrange good insurance coverage.

I LOVE MY JOB!

PLEASE CALL IF YOU'D PREFER THE QUOTE BY PHONE!

Don't be afraid to ask ANY questions!
We Are The Experts For
Motorcycle Insurance in Ontario

Contact any of our 32 brokers

(905) 907-BIKE (2453) or 1-800-917-7283

Great Rates and Quick Claims Service.

Motorcycle Insurance Rates Quoted will be as accurate as possible, based on the facts provided to us. Rates are for the term of one year and are subject to any applicable interest charges relating to payment plans available.
Motorcycle Shield Insurance Ontario Quote Request Form
Please complete all boxes
Due to licensing restrictions, this quotation request is only for residents of the Province of Ontario in Canada.
THE FOLLOWING MOTORCYCLES ARE SURCHARGED BY JEVCO
And the Premiums will average $5,000 to $10,000 if you are less than 29 years old, M licenced over three years, and have a clean record - click here for list

Rider and Licence Information

*  indicates a required field entry

First Name:

*

Last Name:

*

Address:

*

City:

*

Province:

*

Postal Code:

*

Phone Number:

- - *

Fax Number:

- - *

E-mail Address: (only one address please)

*

Date of Birth:

*

Gender:

M/F *

Date Insurance Required:

*

Current 'M Licence" Level:
(Motorcycle Licence Level Explanation)

Safety Training Course:

Date M Licence Obtained
(month/year)

Date M2 Licence Obtained
(month/day/year)

Date M1 Licence Obtained
(month/day/year)

*

*

*

Please note the above licence information is required. If not applicable, enter "n/a"

Your motorcycle drivers licence number?

*

Do you currently hold Motorcycle Insurance?

Yes     No 

If yes, please name Insurer and length of time insured:

Have you had Motorcycle Insurance in the last 3 years?

Yes     No 

If yes, please name Insurer and length of time insured:

Claims/Accidents in the last 6 years?

None 1 2 3

Do you have any moving violation convictions (tickets) in the last 3 years?

None 1 2 3 4

Other M licenced drivers in household?

Yes     No 

If yes, please provide the following information:

Age M Level
Years Licenced
Safety Training Course - Yes No
Currently insured - Yes No

Motorcycle Information

Year, Make and Model:

Year   *
Make  *
Model *

How Many cc's:

*

Purchase Date:

*

Current Actual Cash Value:

*

Bike has H-D factory security system / Sherlock anti-theft engravings / Gorilla / Viper alarm system

Yes     No 

Intended Use of Bike:

Coverage Information

Third Party Liability:

*

Direct Compensation - Property Damage
(deductible must NOT exceed motorcycle value)

*

Collision (see notes for Harleys / Indian)

*

Comprehensive / Specified Perils (see notes for Harleys / Indian):

*
*

Group Discount Rate?
(see approved group list):

Policy Payment Arrangement (see notes):

How Did You Find Us?

Additional Comments:
 (Certain Harley & Super Sport bikes require proof of installation of approved alarm system to qualify for Specified Perils / Comprehensive cover)

Please check that you have supplied all information requested and correctly chosen available options. You can clear the form and start again if unsure. We'll provide a speedy quote!
Motorcycle Shield Insurance looks forward to serving you !

Please click only once

 
Contacts by Phone: 1-800-917-7283 or 905-907-BIKE (2453)
FOR NEW POLICY QUOTES:
John Nelson, New Business: extension 220

Direct Line: 905-907-3269

Call if your last name starts with the letter A to M
Eric Young, Dealer Relations and Special Promotions: extension 230
Call if your last name starts with the letter N to Z
Dealers Only Direct Line: 905-907-3264 to Eric Young
Harley Dealers Direct FAX Line: 905-764-9618
FOR QUESTIONS - SERVICE - CLAIMS - CHANGES:
CALL THE BROKER ACCORDING TO THE FIRST LETTER OF YOUR SURNAME
905-764-7868 or 1-800-917-7283 and extension below
Extension
   Motorcycle Service  
Direct Line
   Client Last Name
231
   Jenny Scott  
905-907-3272
   Aaa-Aiz, C & D
222
   Leslie Wheler  
905-907-3267
   Aja-Amz, E, F & G
205
   Lee Ann Button  
905-907-3273
   Ana-Azz, K, L & T
237
   Eleanor Linde  
905-907-3265
   Baa-Bcz, M & N
216
   Bonnie Male  
905-907-3274
   Bda-Bez, P, R, Saa-Scz
238
   Dorret Steer  
905-326-4527
   Bfa-Boz, Sda-Szz, W & Y
251
   Brett Russell  
905-907-3268
   Bpa-Bzz, H, I, J, O, Q, U, V, X, Z

OUR COMMITMENT TO YOU

NONE of your personal details given to us for purposes of obtaining a quote are shared with anyone other than the Insurance Company.
Email addresses and phone numbers are not sold or shared by J.D. Smith & Associates.
  • We will respond as soon as possible
  • We want to do our best for you
  • Our clients come first
  • Great coverage at Great Rates

MULTI-BIKE DISCOUNTS
(15%)

RENEWAL DISCOUNT
(10%)

GROUP DISCOUNT
(15%)

WE CAN QUOTE SOME VINTAGE BIKE

FAX US COPIES OF YOUR AUTO / HOME POLICIES FOR MAJOR SAVINGS!

John Bell ext. 255
Fax: (905) 764-9618

Phone: (905) 907-BIKE (2453); 1-800-917-7283 (Ontario only)
   Email

Did You Know
The Ontario Motorcycle Association is the best group to join to get the largest discounts

MOTORCYCLE SHIELD PLAN FOR MAXIMUM PROTECTION
Rider Training Institute (Safety Training Courses)
416-516-6151 / 1-866-876-1551

LIST OF APPROVED MOTORCYCLE DISCOUNT GROUPS

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© Motorcycle Shield Insurance, 1999-2008. All rights reserved.

 
 
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