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Bike Insurance


Fill-in your details below then click the Submit button at the bottom of the page.

So that we can process your enquiry more quickly, please fill in all the mandatory fields marked in red.

YOUR DETAILS

Title:
First Name:
Surname:
Address Line 1:
Address Line 2:
Address Line 3:
Town:
County:
Postcode:
Daytime Phone Number
(including STD code):
Evening Phone Number
(including STD code):
Email Address:
Promotional Ref (optional):
What is your occupation?:
What is your marital status?:
DOB:

BIKE DETAILS

Make of Bike:
Model:
Year of make:
Engine Size: cc
Motorcycle License Type:
Years you have held a UK bike license:
No-Claims-Bonus available for this motorcycle:
Where will the motorcycle be kept overnight:
Purchase date of motorcycle:
What bikes have you been insured on over the past 3 years:
Best quote:
Estimated value:
Security:
Type of Cover Required:
Renewal Date:

DRIVING HISTORY

Have you or any other person to be insured on this bike had any:
Accidents or claims in the last 5 years:
Motoring convictions in the last 5 years:

Please tick this box to confirm that you have read and agreed to 'Your Privacy and Security' and wish to proceed.

We can only implement policies in the United Kingdom and the Channel Islands (excluding N.Ireland).

Thank you. Simply click on the submit button and you will be contacted very soon.
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Telephone: 0844 482 8122.   © 2007 All rights reserved. Performance Direct, 5-11 Station Lane, Hornchurch, Essex. RM12 6JL Financial Services Authority