Simply fill out the form below and we will do the shopping for you. 
We do not share your personal information, including your e-mail address,
with anyone other than the insurance companies we represent.

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Motorcycle Quote Request

First Name

Last Name






Email Address

Do you own your home?


Present Insurance Company (If none, please type "None".)

Effective Date (if applicable) mm/dd/yyyy

Driver Information

Please include information for each driver to be covered.

Driver #1 Name

Driver #1 DOB (mm/dd/yyyy)

Driver #1 License No.

Driver #1 SSN (xxx-xx-xxxx)

Driver #1 Accidents/Violations 3 years (If none, please type "None".)

Driver #2 Name

Driver #2 DOB (mm/dd/yyyy)

Driver #2 License No.

Driver #2 SSN (xxx-xx-xxxx)

Driver #2 Accidents/Violations 3 years (If none, please type "None".)

Liability Information

These limits apply for all motorcycles covered.

Bodily injury per person/accident (including uninsured/underinsured at this limit)

Property Damage per accident

Motorcycle Information

Please include information for each motorcycle to be covered

Motorcycle #1 Year (YYYY)

Motorcycle #1 Make

Motorcycle #1 Model

Motorcycle #1 VIN

Motorcycle #1 CC's

Motorcycle #1 Value

Motorcycle #1 Collision Deductible

Motorcycle #1 Comp Deductible

Motorcycle #1 Roadside Assist


 Motorcycle #2 Year (YYYY)

Motorcycle #2 Make

Motorcycle #2 Model

Motorcycle #2 VIN

Motorcycle #2 CC's

Motorcycle #2 Value

Motorcycle #2 Collision Deductible

Motorcycle #2 Comp Deductible

Motorcycle #2 Roadside Assist

Yes No

Your Comments

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Call today to experience the difference of Statewide Insurance!
5718 Hwy 74 West
Indian Trail, NC  28079
Across from Lowe's

Providing all lines of insurance including auto insurance, home insurance, motorcycle insurance, boat insurance, mobile home insurance, commercial auto insurance, and more...

Offering coverage through multiple local, regional and national carriers that specialize in auto insurance and home insurance protection.