Home About Us Services Types of Insurance Online Quotes Carriers Links Video Online Defensive
Driving Course		 Contact Us
 
Privacy Policy-We routinely collect personal and/or business information that is needed as part of the quoting and underwriting process.  We also collect the same information as part of service and update activities.  The Haines & Haines/T.C. Irons Agency will not share that information, or use it in any other way, with outside parties, vendors, etc.

Personal Motorcycle Insurance

 

GENERAL INFORMATION

Street Address
City
State New York ONLY!
Zip Code
 
Marital Status
Single Married 		Is Spouse Vehicle Operator?
Yes No N/A

Homeowner?
 Yes No
Currently Insured?
Yes No
(If YES, list current company below)
 
If Not Currently Insured
When did Coverage End?

Are You a member of a Motorcycle Group?
Yes No

(If yes, list Motorcycle Group below
i.e. HOG, Cycle USA, Etc.)

Have you Attended a Motorcycle Safety Course?
Yes No

(If yes, list Motorcycle Course Date below)

Have you Attended an Automobile Defensive Driving Course?
Yes No

(If yes, list Auto Defensive Driving Date below)
 
CURRENT MOTORCYCLE
COVERAGE
Liability Limits
 $25k/50k $50k/100k
$100k/300k $250k/500k
None

DRIVER INFORMATION
Name Birth date
Sex (M/F) # Yrs U.S. Cycle
 Licensing
    # Yrs Total Cycle
 Experience

In order to obtain all available DISCOUNTS, carriers run a low level insurance credit check. By providing Social Security # and Driver's License #, we can obtain the
LOWEST RATE AVAILABLE!
Driver 1 Social
Security #		 Driver 1 Driver's
License #

- IMPORTANT INFORMATION -
 To receive an accurate quote, you must provide information regarding the
approx. DATE and TYPE of any CLAIMS or TRAFFIC VIOLATIONS
within the last 39 MONTHS.
DATE CLAIM / TRAFFIC VIOLATION TYPE








VEHICLE INFORMATION
Year of vehicle    
Make:     
Model:     
Annual Mileage Used in business?
(Explain, if yes)
CC's Miles Driven to Work?
Alarmed? Y N Garaged? Y N
Current Motorcycle Value
Motorcycle Accessories Value
REQUESTED VEHICLE COVERAGES
MANDATORY COVERAGE  Please Select One Option:
(25/50/10 is the minimum allowed by law)
BI/GP - PD
(See Definitions)		 25 / 50 / 10    100 / 300 / 50
50 / 100 / 25  250 / 500 / 100
For  FULL COVERAGE  Please Select a Deduct able Below
Comprehensive
& Collision		 NO Coverage $250 Deductible
$500 Deductible $1000 Deductible
Comments or Remarks:

 CONTACT INFORMATION
First Name

Last Name

Email

Phone                        Fax
  
Questions / Comments / Notes
Send my quotation via E-Mail Fax
Regular Mail
Call me by Phone!

All quotes are based on the information that the applicant  provides, and are subject to change based on final underwriting by the  individual carriers.

 


Our Mission Statement
Dating back from 1872 our mission is clear:
To serve our clients with the utmost respect, integrity and professionalism while providing a comprehensive risk management program at competitive pricing
 


Get a Quote

Contactenos ahora, hablamos su idioma.

 

 

Policy Coverage
and Disclaimer


  Haines & Haines/ T.C. Irons  
16 West Front Street
Florence, NJ 08518
Phone: 609.499.0237 
Fax: 609.499.4077		 230 High Street PO Box 158- Burlington, NJ 08016
Phone: 609.387.0606
Fax: 609.387.5337
 1-3 Bank Street
Suite E
Medford, NJ 08055
Phone: 609-953-2282 
Fax: 609.953.7719
  Wesley Insurance Service Agency
1194 Parkway Avenue Trenton, NJ 08628
Phone: 609.883.4190
Fax: 609.538.0274