Motorcycle Quote Page Free Insurance Quote Pennsylvania Car Truck Auto Cycle Health Life Disability Home Homeowners Farm Farmowners Matthias Insurance Agency Inc, Kutztown, PA



Call Us Toll Free: 1-877-GO-TO-MIA (1-877-468-6642)
Request Quotes	For quotes or info other than auto, motorcycle/atv, homeowners, or snowmobile, click the Request General Info button. As an independent agent, WE DO THE SHOPPING FOR YOU, since we represent numerous companies. New PA residents: GO HERE to see PA's requirements about registering your motor vehicle/cycle and obtaining a PA drivers license. ASK THE DCNR! Everything you need to know about: ATV MANDATORY Insurance, titling, licensing and registration in PA Important note: ATV compliance is overseen by DCNR, NOT PennDot!

MOTORCYCLE/ATV REQUEST FOR QUOTATION VIA SECURE SERVER

Pennsylvania Only

As an independent agent, WE DO THE SHOPPING FOR YOU, since we represent numerous companies, finding the best one to suit your needs.

To receive a quotation for motorcycle coverage, fill out the form below as completely as possible. We will contact you with a quotation in most cases, within 24 hours. Please note the importance of providing us with your phone number in case we have further questions...OR, if you don't feel like filling out the form, just call and we can take your information over the phone or meet with you personally.
Important notice: Although it's not necessary to include your social security number for a quote, SOME of the insurance companies we represent DO require it in order to receive a quotation. If you do not provide it, you are reducing the number of companies from which we CAN obtain proposals.

Important:

Do not hit the enter key while filling out the form or your information will be prematurely submitted. If this occurs you will have to start over to re-send a complete form. Use the tab key or mouse to move from field to field.

General Information
First Name:
Last Name:
Address:
City:
State:
Zip Code:
County:
Township:
Day Phone w/ AC:
Evening Phone w/ AC:
Fax w/ AC:
Email:
Your social security number (not required if you are under age 21):
Your spouse's social security number (not required if spouse is under age 21):

Important: Please provide your phone number OR email address or both, (preferably your phone number) in case we have additional questions regarding your inquiry. If we do not have one or the other, we may not be able to provide your requested quotation. Thanks!

Quicktip

Use the up and down arrow keys to view the selections in the drop down boxes in the forms below instead of clicking with your mouse.

Driver Information
ALL operators who will be driving the cycle(s) MUST be listed.
Driver First Name	Relation to you	Years experience on units 625cc or larger	Birth Date (mo/day/yr)	Married/ Single	Safety Course?	Licensed in PA for cycle?	# of Yrs Licensed
	Self			M S	Y N	Y N
				M S	Y N	Y N
				M S	Y N	Y N
				M S	Y N	Y N

Pennsylvania Coverage Options
Listed below are the most common, but NOT ALL the coverages available.
Bodily Injury and Property Damage Liability
Uninsured and Underinsured Motorists
Medical Payments
Pedestrian Basic First Party Benefits

Cycle/ATV Information
Unit	Year	Make	Model	Vehicle ID# (VIN)
1
Purchase Date of Unit			Comp Deductible	Collision Deduct	Anti-theft
(mo/day/yr)
Cycle/ATV CCs			Driven mostly by (Enter driver name)
Is unit garaged?			Actual cash value of any accessories to be insured
			$

Cycle/ATV Information
Unit	Year	Make	Model	Vehicle ID# (VIN)
2
Purchase Date of Unit			Comp Deductible	Collision Deduct	Anti-theft
(mo/day/yr)
Cycle/ATV CCs			Driven mostly by (Enter driver name)
Is unit garaged?			Actual cash value of any accessories to be insured
			$

Cycle/ATV Information
Unit	Year	Make	Model	Vehicle ID# (VIN)
3
Purchase Date of Unit			Comp Deductible	Collision Deduct	Anti-theft
(mo/day/yr)
Cycle/ATV CCs			Driven mostly by (Enter driver name)
Is unit garaged?			Actual cash value of any accessories to be insured
			$

Driver History
Has any driver been convicted of ANY moving traffic violation, in the last 36 months, or had a license suspension/revocation, or been convicted of driving under the influence of alcohol or drugs in the past 5 years?
If you answered "Yes" to the above question, provide details below.
Driver Name	Date	Type Of Occurrence






Answer the following:
Has any driver been involved in ANY accidents regardless of fault, or made any claims to his or her insurance company for ANY reason in the past 5 years?
If you answered "Yes" to the above question, provide details below.
Driver Name	Date	Accident Or Insurance Claim Description

Miscellaneous Information
Complete ALL questions below. Answering them may qualify you for discounts and lower auto rates.
Do you currently have cycle insurance?
If you answered "Yes" to the above question, provide details below.
Company Name:
Current Premium:
Policy Expiration Date:	(mo/day/yr)
Answer the following:
Has your policy been CONTINUOUSLY in force for the past 12 months?
Do you have a MasterCard or VISA?
Include any particular questions, concerns or requests regarding your quotation here. *IF THIS IS A REQUEST FOR AN ATV QUOTE, PLEASE INDICATE THAT HERE...*
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