Free Quote

Milazzo Insurance Agency is a full service motorcycle insurance agency.
In order to match you with the right insurance company for you
and find you the coverage you need, please fill out this quote sheet.
When you are done, submit this form ( submit button at bottom of form)
and we will contact you. Please fill out all fields.

PLEASE NOTE: You must have a valid License AND your bike MUST be garaged in New York.

For New York Residents Only

Your Full Name:
Street Address:
City, State Zip
Date of Birth:
Garaging Zip Code:
Marital Status:
Your E-Mail Address:
Number of years cycling experience:
Number of years licensed?
Do you have a valid m/c license or permit?
Within the last 40 months, are there any violations and/or accidents on your driving record?
If Yes, How many of each: Violations:
Accidents:
Minor Violations? (speeding, stops, red lights, etc):
Major Violations: (DWI, etc.)

At-Fault Accidents (All accidents appearing on your driving record are considered at fault unless you provide proof of non-fault
(for example, a police report, copy of check that you received from other company). Explain any not at fault accidents below:

Cycle Year:
Make:
Model:
CCs:

Coverage Requested:

Liability:
Fire/Theft:
Collision:
Is your bike stored in a locked garage at night?
Have you completed a Motorcycle Safety Course within the past three years?

Any additional information you would like to include about yourself,
a second or third bike, or to explain any accidents that may appear on your record.