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Get a FREE rate quote today with Vern Fonk Insurance. Just fill out our simple form and sit back and wait to be contacted by one of our representatives.
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Motorcycle Rate Quote Request

STOP! Our internet customers can go to the front of the line!

Vern Fonk Insurance gives our internet customers special attention by sending them to the front of the line. Please call during business hours: 9 am - 6 pm, Monday through Friday and 9 am - 2 pm on Saturday for immediate assistance on all your insurance needs.To make an appointment today, call 1 (800) 654-7722!

Internet customers only!


Please fill out the form below and we will contact you with an insurance quote and answer any questions you have. Required fields are marked with a * , however to receive the most accurate quote we prefer that you answer all the questions.

*Before starting: Please select the city nearest you!

Tell Us About Yourself
*First Name:
Middle Initial:
*Last Name:
*Day Phone:    –   ext.
*Address:
*City:
*State:  
*Zip code:
Cell Phone:    –   ext.
*Email:
*Gender:
*Date of Birth (mm/dd/yyyy): / /
*Marital Status:
Occupation:
How many years have you been licensed? /yrs
Current Insurance Company (if applicable):
How long have you been with your current provider: /yrs /mo
Need an SR-22 filing? Yes     No
Home owner? Yes     No

Tell Us About Your Spouse (if applicable)
*Spouse's First Name:
Spouse's Last Name:
*Gender:
*Date of Birth (mm/dd/yyyy): / /
Occupation:
*How many years have your spouse been licensed? /yrs
Current Insurance Company (if applicable):
How long has your spouse been with his/her current provider: /yrs /mo
How many years of motorcycling experience does you spouse have?

How did you hear about us?
*How did you hear about us?
Have you taken the Motorcycle Safety Foundation Course?
Yes     No
Years of riding experience

Tell Us About Your Motorcycles
*If you have more than 3 vehicles, please make note in the comments area at the bottom of the form.

Motorcycle One
*Year:
*Make:
*Model:
Sub-Model (ie: LX, GTI):
Vehicle Identification Number (VIN):
Garaged or Locked Storage?:
Garage zip(if different):
Licensed for road use:
Medical Payments:
Uninsured Motorists: Yes     No
*Comprehensive (DEDUCTIBLE):
*Collision (DEDUCTIBLE):
*Value of Additional Equipment & Accessories:
*Engine size (in cc's):

Motorcycle Two
*Year:
*Make:
*Model:
Sub-Model (ie: LX, GTI):
Vehicle Identification Number (VIN):
Garaged or Locked Storage?:
Garage zip(if different):
Licensed for road use:
*Comprehensive (DEDUCTIBLE):
*Collision (DEDUCTIBLE):
*Value of Additional Equipment & Accessories:
*Engine size (in cc's):

Motorcycle Three
*Year:
*Make:
*Model:
Sub-Model (ie: LX, GTI):
Vehicle Identification Number (VIN):
Garaged or Locked Storage?:
Garage zip(if different):
Licensed for road use:
*Comprehensive (DEDUCTIBLE):
*Collision (DEDUCTIBLE):
*Value of Additional Equipment & Accessories:
*Engine size (in cc's):

Additional Information
Please provide any additional driver, vehicle or violation information
that will help us process your Insurance Quote:

Contact Options
*How should we reach you?
Day Phone   Cell Phone

* Required Fields

Thank you for your quote request. Our agents will get back to you as soon as possible with your quote. Happy Motoring!

 

 

 

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