Insurance Score / Claim History Disclosure
In connection with this application for insurance, we may review your credit report or obtain or use a credit-based insurance score based on the information contained in that credit report. We may use a third party in connection with the development of your insurance score. In connection with this application for insurance, we may review your claims history or loss experience and may report future claims made by you to a claims history provider. 
Applicant agrees to these terms.*
Motorcycle/ATV/Golf Cart Quote Form
When you fill out and submit this form, one of our agents will take your information and provide you a quote within two business days. If you would like an immediate quote, call 1-866-884-6167 Mon - Fri 8 a.m. - 8 p.m ET.

This form allows you to provide information for one boat. If you have two or more boats, we can insure them – just call us!

All fields marked with an asterisk are required. You may find it useful to have your current policyor declarations page handy.
First Name*
Last Name*
If you do not have an email address, please give us a call at 866-880-8651. 
Date of Birth (mm/dd/yyyy):*
Zip Code:*
How did you hear about us?*
If Agent, who is the agent?
Additional Applicant Information
If the motorcycle/ATV/golfcart is garaged in another state, please provide that state here:
What date do you want your coverage to take effect (mm/dd/yyyy)?*
Do you currently have a valid motorcycle license?*
Are you a member of a snowmobile club or association? You may qualify for a discount
If so, please provide the name of the club:
Vehicle Information
Vehicle Type:
Current market value:*
Model Year:*
VIN Number:
Engine size (cc's): *
Is the cycle/unit currently insured? *
If yes, who is your current insurance company?
Is the cycle a trike?
Is the cycle a street driven unit?
Is the motorcycle/ATV/golfcart kept in a secure location (i.e. locked garage) at night?
Accident/Violation Information
Thinking about the past three years of your driving record, please indicate the number of each type of violation that you have. Note that we do verify this information when a policy is purchased.
Number of minor violations: *
Number of major violations: *
Number of at-fault violations: *
Coverages and Limits
You may find it helpful to have your current policy in front of you when filling out this information.
Amount of Bodily Injury coverage: *
Amount of medical payments coverage: *
Amount of property damage coverage:*
Amount of uninsured/underinsured motorist bodily injury coverage:*
Please provide the following information so we can contact you with your quote.
We respect your privacy and will never sell or rent your contact information to third parties.
How would you prefer that we contact you?*
Daytime Phone Number
Alternate Phone Number
Best Time to Contact
American Modern may periodically email you news and information related to specialty insurance products.
If you prefer not to receive these communications, please opt-out here.