Quote

H. G. Ellis Agency, Inc.

For All Your Insurance Needs

Camden (315) 245-1270, Constantia (315) 623-7765, Cazenovia (315) 655-9066

Please bear with us while we get the electronic submission form set up. Please call or e-mail the closest office for quote or appointment.




		Get A Quote- Motorcycle / ATV / Snowmobile

	Please fill out the following form to the best of you knowledge and we will quote your policy as soon as possible. If we need additional information we will contact you.




Oneida Lake/ Ft. Brewerton Chamber of Commerce



Camden Chamber of Commerce



Cazenovia Chamber of Commerce

The following questions are used to help determine the proper company and rate to assign to your risk. Answering the questions will only help your rate and will not hurt it. You do not have to answer anything you do not want to. We do not give out or sell any information provided. We will run motor vehicle reports and accident reports to verify all information provided.


	Name


	Mailing Address


	Garaging Address


	Phone #


	Preferred method of contact




		US Mail


	Email


	Phone


	Email


	DRIVERS


	Please list anyone who may drive the vehicle


	Name


	DOB


	License Number

	# Years Licensed


	License State


	Do you have a motorcycle license


	Social Security #


	Years of rec. vehicle experience


	Name


	DOB


	License Number

	# Years Licensed


	License State


	Do you have a motorcycle license


	Social Security #


	Years of rec. vehicle experience

		Additional Drivers

	Name




		DOB


	License #


	License state








		Tickets and/or Accidents


	Please list the driver, date and details of any accident or ticket received in the last 5 years


	Driver


	Driver


	Discount Info.


	Do you currently have MC/ATV/ Snowmobile insurance


	If yes, what company

	Is the vehicle garaged


	Annual premium


	Are you a member of a club


	Did you take the Defensive driving or other safety course


	Are you a homeowner


	To receive a discount, can you provide proof of ownership


	Vehicle Info.


	For vehicle type, please put an (A) for ATV, a (M) for motorcycle, (S) for snowmobile or (O) for other.


	Year


	CC’s/ engine size


	Make


	Unit Value


	Model


	VIN/ serial number; usually 17 characters


	Custom accessory value


	Vehicle Type


	Would you like physical damage on this unit


	Year


	CC’s/ engine size


	Make


	Model


	Unit Value


	VIN/ serial number; usually 17 characters


	Custom accessory value


	Vehicle Type


	Would you like physical damage on this unit


	Coverage Options


	If you don’t know what something is put not sure in box and we can discuss


	Liability


	Medical Payments


	OBEL


	Comprehensive Deductible; not all amounts are available with all companies


	Uninsured/ Underinsured Motorists




			Additional PIP



	Collision Deductible; not all amounts are available with all companies


	Please call or email the closest office with the information.


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