Form-Policy Review

POLICY REVIEW
We appreciate the opportunity to review your current or recently expired insurance policy. Privacy is your right and our concern. Are you getting the lowest rate? Do you have the proper coverage? Are you with the correct company for you ? We can answer these questions for you by reviewing your policy. This service is free. All you will need to do is fax us (631-476-1378) a copy of your current declaration page and fill out a policy review form. After we receive your information, we will review your policy line by line and determine if we can offer you a better policy.

Policy Review - We Make it Easy !

Please Fax us your Declaration page - This page shows your coverage and price paid.
Please Fill in form below and submit form
We will get back to you in a timely manner!

Web Form: Policy Review- For an accurate quote, please fill in all fields of this six (5) part form. You can easily navigate this form using the Tab key.

#1-Insured's Information
Last Name
First Name
Middle Initial
Street Address
City or Town
State
Zip Code
Date of Birth
Occupation
Social Security#
Driver License #
Contact Phone
Fax
E-mail

#2-Motorcycle Information

If Motorcycle Information is not the same as your current information, Please fill in Motorcycle Information below.

Or if Information is same- go to " Type of Coverage Desired"

Unit 1

Unit 2 (optional)

Year

Make

Model

CC'S

Vin #

#3-Type of Coverage Desired
What Type of Policy are you looking for?
Pick Limits of Liability and Physical Damage
Please Choose Deductible for Comp. & Coll.
Do you want optional Spousal Liability?
Do you want optional OBEL (Pedestrian)?
Do you want Optional Medical Payments?
Do You want Optional Roadside Assistance?
Do You want optional Towing?

#4-Underwriting & Discount Questions
Your Marital Status
D0 you have a Motorcycle License?
Years of Motorcycle Experience?
Is Motorcycle Kept in locked Garaged?
Major Tickets/Violations in the last 39 months?
Driver Training or Safety Course Certificate?
Member of Motorcycle Rider Group?
Are You a Homeowner?
Do you need a Lien holder listed on Policy

#5-Use text box for any questions or comments.

Please list all tickets, accidents or violations in last 39 months

Do you want to list an additional operators?

How did you find us?

It is our goal to provide you with the best coverage at the lowest price from one of top quality insurance companies we represent. We look forward to serving you in the near future.

How should we contact you? Phone Fax E-mail Regular Mail
Thank you for taking the time to fill out this form -worksheet. We will use the information you supplied along with your DMV records and your consumer reports which include your credit and financial responsibility information to review your policy and obtain an insurance quote for you. This information will be kept confidential and is used by us and the insurance companies we represent for rating purposes only and will not be shared with any one else. By submitting this form you are authorizing us to access your information, review policy and provide you with a quote.

Kenneth Veale

Ryde Insurance Agency

106 W Broadway

Port Jefferson, New York, 11777

E-mail: Rydemc@aol.com

E-mail: Ryde Insurance Agency

Phone:631-476-0722

Fax: 631-476-1378

Please Fax your current insurance Declaration Page to us at 631-476-1378. The Declaration Page is the page that shows your coverage and what you pay for the coverage. We will get back to you in a timely manner.