Full Name:          
Mailing Address:
City:
State:  Washington or Idaho
Zip Code:
Email Address: (Required) 
Home Phone:   Work Phone:   Ext.
How to Contact You:       Cell Phone:
Current Insurance Company: 
Policy Expiration Date:          (mm/dd/yyyy)

Washington Motorcycle Insurance Information:

  Cycle       Year             Make               Model              Type
     1        
     2        

Cycle      Primary Use     Miles Driven to Work     CC's
     1                       
     2                       

Cycle
     1   Is motorcycle garaged?    If Yes, is it locked?
     2   Is motorcycle garaged?    If Yes, is it locked?

Does your motorcycle(s) have an alarm?
Cycle
     1      
     2      

Choose Washington Motorcycle Insurance Coverage Amounts:

                      Liability                 Property                   Uninsured
  Cycle    Limits(x $1,000)          Damage             Motorist(x $1,000)         Medical
     1                                     
     2             SAME                       SAME                       SAME                   SAME

                   Collision         Comprehensive
  Cycle    Deductible           Deductible
     1             
     2             

Washington Motorcycle Driver Information:

                            Drivers                        Date of                                   Drivers
Driver                 Name                             Birth           Gender             License #
     1                   
     2                   


                            Drivers                  How Long          Marital                  Social
Driver              Occupation                Licensed            Status                  Security #
     1                   
     2                   

Driving record accident & violation free during the past 3 years?
If No, how many accidents?    How many violations? 

Claims of losses to motorcycle(s) or from liability in the past 5 years?
Description of losses:


Have you taken any safety courses in the last 5 years?

Additional Information or Comments



Click on the "Submit Quote Request" button below to send
your Washington Motorcycle Insurance quote request.**


**Information received from this Washington Motorcycle Insurance quote request
form sent to The Fletcher Agency will be for our use only and will not be sold,
given to or distributed to any other parties. A quote will be based on the Washington
motorcycle insurance policy information provided and does not guarantee
acceptance of the risk by us. The precise coverage afforded is subject to
meeting underwriting guidelines, and the terms, conditions and exclusions of
the policy as issued. By submitting this request you acknowledge that this is
neither an offer to insure nor a guarantee of insurance. Completion of this form
does not entitle you to a Washington Insurance policy. We are licensed in Idaho
and Washington, and will not provide motorcycle insurance quotes for other states.


Washington Motorcycle
Insurance Quote
We can provide lower cost Washington Motorcycle Insurance
coverages in Spokane County, WA and throughout the Evergreen State!
The Fletcher Agency of
Spokane, WA offers
affordable and
experienced personal
insurance coverage
services throughout
Washington.
Contact us about
Washington Auto,
Renters, Homeowners,
Boat, Motorcycle,
Earthquake, Flood, and
Condominium Insurance
at (509) 324-6311.

In addition to
Washington Motorcycle
Insurance quotes, we
also offer affordable
Spokane, WA Flood
Insurance policy
quotes.
We are a Spokane, WA insurance agency offering affordable
Washington motorcycle insurance quotes in the following towns,
cities and counties in Washington state: Opportunity, Millwood,
Dishman, Seven Mile, Veradale, Spokane Valley, Trentwood,
Pasadena Park, Glenrose, Country Homes, Greenacres, Newman
Lake, Otis Orchards, Airway Heights, Mead, Colbert, Buckeye,
Chattaroy, Milan, Deer Park, Elk, Clayton, Tumtum, Long Lake,
Ford, Deep Creek, Reardan, Four Lakes, Medical Lake, Espanola,
Marshall, Tyler, Cheney, Vallyford, Spangle, Plaza, Mica, Freeman,
Manito, Fairfield, Waverly, Rockford, Whitman County, Pend Oreille
County, Lincoln County, Stevens County, and Spokane County,
WA. We can also offer lower cost Washington motorcycle
insurance policy quotes throughout the state of Washington.

Applicant Information
WA Motorcycle
Insurance Terms
The Fletcher Agency
421 W. Hastings Road
Spokane, Washington 99218
Spokane County, WA
Office: (509) 324-6311
Fax: (509) 324-6340

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