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Motorcycle Insurance Quote

Personal Information
Name:*
Address:
Street Address City State ZIP Code
Phone:*
Email:*
Are You Currently Insured?:
- Yes
- No
Current Insurance Information
Insurance Company Name (not agency):
Policy Expiration Date:
Month
Day
Year
Years Insured:
Premium Amount:
Term:
- 6 Months
- 1 Year
Motorcycle Information
How Many Motorcycles?
- One
- Two
- Three
Motorcycle #1 Information
Year:
Make:
Model:
Annual Mileage:
Drive to school/work?
- Yes
- No
Number of miles to school/work:
Is Motorcycle #1 kept at a location other than that listed in your personal information above?
- Yes
- No
Address where Motorcycle #1 is kept:
Street Address City State ZIP Code
Comprehensive Deductible:
Collision Deductible:
Towing:
- Yes
- No
Loss of Use:
- Yes
- No
Motorcycle #2 Information
Year:
Make:
Model:
Annual Mileage:
Drive to school/work?
- Yes
- No
Number of miles to school/work:
Is Motorcycle #2 kept at a location other than that listed in your personal information above?
- Yes
- No
Address where Motorcycle #2 is kept:
Street Address City State ZIP Code
Comprehensive Deductible:
Collision Deductible:
Towing:
- Yes
- No
Loss of Use:
- Yes
- No
Motorcycle #3 Information
Year:
Make:
Model:
Annual Mileage:
Drive to school/work?
- Yes
- No
Number of miles to school/work:
Is Motorcycle #3 kept at a location other than that listed in your personal information above?
- Yes
- No
Address where Motorcycle #3 is kept:
Street Address City State ZIP Code
Comprehensive Deductible:
Collision Deductible:
Towing:
- Yes
- No
Loss of Use:
- Yes
- No
Liability Limit For ALL Motorcycles
Choose Either:
- Bodily Injury and Property Damage
- Single Limit
Bodily Injury:
Property Damage:
Single Limit:
Driver Information
How many licensed drivers in your household?
- One
- Two
- Three
- Four
Driver #1 Information
Driver Name:
First Last
Relation:
Number of Years Licensed:
Date of Birth:
Gender:
- Male
- Female
Marital Status:
- Married
- Single
Drivers Ed:
- Yes
- No
Has this driver had their license suspended or revoked?
- No
- Suspended
- Revoked
Has this driver had any DUI convictions for:
- No DUI Convictions
- Alcohol
- Drugs
Driver #2 Information
Driver Name:
First Last
Relation:
Number of Years Licensed:
Date of Birth:
Gender:
- Male
- Female
Marital Status:
- Married
- Single
Drivers Ed:
- Yes
- No
Has this driver had their license suspended or revoked?
- No
- Suspended
- Revoked
Has this driver had any DUI convictions for:
- No DUI Convictions
- Alcohol
- Drugs
Driver #3 Information
Driver Name:
First Last
Relation:
Number of Years Licensed:
Date of Birth:
Gender:
- Male
- Female
Marital Status:
- Married
- Single
Drivers Ed:
- Yes
- No
Has this driver had their license suspended or revoked?
- No
- Suspended
- Revoked
Has this driver had any DUI convictions for:
- No DUI Convictions
- Alcohol
- Drugs
Driver #4 Information
Driver Name:
First Last
Relation:
Number of Years Licensed:
Date of Birth:
Gender:
- Male
- Female
Marital Status:
- Married
- Single
Drivers Ed:
- Yes
- No
Has this driver had their license suspended or revoked?
- No
- Suspended
- Revoked
Has this driver had any DUI convictions for:
- No DUI Convictions
- Alcohol
- Drugs
Driving History
Please list any convictions for any driver convicted of moving traffic violations in the past 3 years.
Driver: Date: Description: Fines ($): Speed Over Limit (MPH):
Please list any driver involved in accidents, regardless of fault, in the past 5 years.
Driver Name: Date: Description: Cost ($): Fines ($): Were there injuries?: At Fault?:
Excess Liability
Personal Umbrella Coverage:
- Yes
- No
Coverage Amount:
Additional Comments or Questions
Phone
This field is for validation purposes and should be left unchanged.

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Shelbyville Office

Koonce Insurance Agency

1604 W Main Street
Suite 300
Shelbyville, Illinois 62565

Mailing Address
P.O. Box 476
Shelbyville, Illinois 62565

Phone: (217) 774-5581

Mon-Fri: 8:30am-5:00pm
Sat-Sun: Closed

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Mattoon Office

Koonce Insurance Agency

1404 Broadway Avenue
Mattoon, Illinois 61938

Phone: (217) 235-3167

Fax: (217) 235-3168

Mon-Fri: 8:30am-5:00pm
Sat-Sun: Closed

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Pana Office

Koonce Insurance Agency

306A East 1st Street
Pana, Illinois 62557

Phone: (217) 562-4010

Mon-Fri: 8:30am-5:00pm
Sat-Sun: Closed

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Koonce Insurance Agency provides auto insurance, home insurance, life insurance, health insurance, business insurance, and employee benefits to all of Illinois, including Shelbyville, Pana, Taylorville, Sullivan, Mattoon, Charleston, Effingham, Decatur, Mt. Zion, and Vandalia.

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