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Search for:
Midwest Polaris
Eric Fisher
2023-02-26T13:35:40-05:00
Midwest Polaris
has partnered with Outdoor AdvINSURE to get you on the trail with the right insurance coverage
Simply enter your information below and Outdoor AdvINSURE will reach out with your quote.
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1
Basic Info
2
Vehicles
3
Coverage
4
Final Questions
What date would you like this policy to start?
*
MM slash DD slash YYYY
Insured Name
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First Name
Last Name
Insured's Date of Birth
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Drivers License State
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Education Level
*
- Select -
No high school diploma or GED
High school diploma or GED
Vocational / trade school degree or military training
Completed some college
Currently in college
College degree
Graduate work or graduate degree
Primary Residence
*
- Select -
Own Home/Condo
Own Manufactured Home
Rent
Live With Parents
Other
Is there a Co-Insured?
If no, leave blank
Yes
Co-Insured Information
Co-Insured Name
*
First Name
Last Name
Co-Insured Date of Birth
*
MM
1
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DD
1
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3
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5
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11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Co-Insured Gender
*
- Select -
Male
Female
Prefer Not to Answer
CoInsured Marital Status
*
- Select -
Single
Married
Domestic Partner (Unmarried)
Widowed
Separated
Divorced
Fiance or Fiancee
Other
Unknown
Civil Union / Registered Domestic Partner
Co-Insured Drivers License Number
*
Co-Insured Drivers License State
*
- Select State -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Co-Insured Education Level
*
- Select -
No high school diploma or GED
High school diploma or GED
Vocational / trade school degree or military training
Completed some college
Currently in college
College degree
Graduate work or graduate degree
Vehicle 1 Information
Vehicle Type
*
- Select Vehicle Type -
Motorcycle
ATV/UTV
Golf Cart
Dirt Bike
Moped
Autocycle
Snowmobile
Segway
VIN
Year
*
Make
*
Model
*
CC Size
*
Primary Use
*
Pleasure
Commute
Business
Other
Modified frame, turbo, or nitrous kit
No
Yes
Lienholder
No
Yes
Lienholder Name
*
Purchase Price (New Purchases Only)
Add a second unit?
No
Yes
Vehicle 2 Information
2: Vehicle Type
*
- Select Vehicle Type -
Motorcycle
ATV/UTV
Golf Cart
Dirt Bike
Moped
Autocycle
Snowmobile
Segway
2: VIN
2: Year
*
2: Make
*
2: Model
*
2: CC Size
*
2: Garaging Zip Code
*
2: Primary Use
*
Pleasure
Commute
Business
Other
2: Modified frame, turbo, or nitrous kit
No
Yes
2: Lienholder
No
Yes
2: Lienholder Name
*
2. Purchase Price (New Purchases Only)
Coverage Information
Coverage Level
*
- Select -
Basic - $1000 Deductibles, $50k/$100k Liability, $3,000 Accessories, includes Roadside
Standard - $500 deductibles, $100k/$300k Liability, $5,000 Accessories, includes Roadside
Premier -$250 Deductibles, $250k/$500k Liability, $10,000 Accessories, includes Roadside
Customize my coverage
Bodily Injury & Property Damage Liability
*
- Select -
$50,000/$100,000/$50,000
$100,000/$300,000/$100,000
$250,000/$500,000/$250,000
Uninsured/Underinsured Motorist Liability
*
- Select -
$50,000/$100,000/$50,000
$100,000/$300,000/$100,000
$250,000/$500,000/$250,000
Comprehensive Deductible
*
- Select -
100
250
500
1000
None - Liability Only
Collision Deductible
*
- Select -
100
250
500
1000
None - Liability Only
Accessory Coverage
*
- Select -
$1 - $3,000
$3,001 - $4,000
$4,001 - $5,000
$5,001 - $6,000
$6,001 - $7,000
$7,001 - $10,000
$10,001 - $15,000
$15,001 - $20,000
$20,001 - $25,000
$25,001 - $30,000
Do you want to include coverage for a transport trailer?
*
No
Yes
Trailer Value
Possible Discounts
Motorcycle Endorsement
*
No
Yes
Safety Course Completed within the last 3 years?
*
No
Yes
Years Riding Experience
*
Ride How Often
*
- Select -
5-7 Days Per Week
3-4 Days Per Week
1-2 Days Per Week
1-3 Days Per Month
Will unit be registered for street use?
*
No
Yes
Have you had any moving violations or claims in the past 5 years?
*
No
Yes
Have you had motorcycle insurance in the last 12 months?
*
No
Yes
Prior Motorcycle Insurance Company Name
*
Motorcycle Policy Expiration Date
MM slash DD slash YYYY
Final Questions
How would you prefer to be contacted?
*
Phone
Text
Email
Please let us know the best time to contact you to discuss your quote
*
Morning
Afternoon
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Anytime
Consent
*
Like most insurance agencies, we use information from you and other sources, such as your driving and claims histories, a credit based insurance score, and other factors to calculate an accurate rate for your insurance. New or updated information may be used to calculate your renewal premium. All the above information is accurate and true to the best of my knowledge.
I Agree
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