Christine Tillett
MetLife Auto & Home
Insurance protection for all your needs with integrity and honesty
33305 1st Way S #B102
Federal Way, WA 98003
253-838-5797 (fax)

Our agency is licensed to quote and write insurance policies only in Washington. To find agents offering these coverages in all other states, please click the logo.


 Motorcycle Insurance Quote
Completely fill out and submit this form to our agency to receive an accurate quote. You MUST provide at least one method of contact to receive a quote from our agency.

General Information

 Name: (required)  
 E-Mail Address: (required)  
 City: (required)  
 State:(required)   Zip: (required)
 Day Phone:  
 Evening Phone:  

   Name  Date of Birth  Sex  Married/Single  M/C Exp
Rider #1    
 Rider #2          
 Rider #3          
 In order to provide a PREFERRED policy quote some of the companies that we represent may require a credit and/or claims history. For Preferred quotes, Social Security numbers are required. You do not have to provide social security numbers at this time but we can't guarantee that we can provide the best price available until after we speak with you and secure this credit and/or claim information.
Check this box to grant our agency permission to secure your credit and/or claim history, for insurance purposes only, under the Fair Credit Reporting Act. Your name

We need to know about your cycles.
All of this information is required to receive a quotation
  Year Make Model  Eng Size (CC)  Value ($)
Cycle #1
Cycle #2
Cycle #3

Motorcycle Insurance Coverage
 Desired Coverage      Liability only Liability/Comp  Full Coverage
Liab Limits Deductible Uninsured
Cycle 1
Cycle 2
Cycle 3

Accidents & Violations

Last 3 Yrs (Minors)
Last 5 Yrs (Majors)
Driver 1 Driver 2 Driver 3 Driver 4
Minor Violations - Speeding, Illegal Turn, Stop Sign, Red Light, etc. (Within the last 3 years)
Accidents - Non Chargeable (Within the last 5 years)
Accidents - Chargeable (Within the last 5 years)

The following information is optional, but if given we will be able to provide you with a more accurate premium quotation.
 Drivers' Information:  
 Driver #  License Number  

Motorcycle Identification Numbers
 Veh #1
  Veh #2
 Veh #3

Please use this area to give us any additional information that you may feel is important for your insurance.

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Page Created 8-13-2004
Latest Revision