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No coverage is bound until confirmed by one of our staff members

Motorcycle Quote Request

 Name  
 Street Address  
 Street Address  
 City, State, Zip  
 Phone Number   Home    Work 
 Current residence is:  
 Driver Information
 Name  
 Social Security Number  
 Date of Birth  
 Marital Status  
 List all citations received in the past
 3 years (Please include non-moving
 violations)
 
 List all accidents.  
 Motorcycle Information
 Year, Make, Model  Year Make Model
 Vehicle ID Number  
 Body style  
 Engine CC's  
 List any club membership, Goldwing etc.  
 Have you taken a motorcycle safety course?  
 Select coverage and limits below
 Liability  
 Un(der)insured Motorist

  Will Match Liability
  Selection

 Medical/ Personal Injury Protection

  Will Match Liability Selection

 Comprehensive  
 Collision  
 Please use the space below to add comments regarding any special circumstances or
 coverage needs

 




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Contact Us

For information about Cassidy Insurance please contact:
Swampscott Office:
Tara Cassidy-Driscoll
Colleen Jordan
Dorothia Zolotas
Connie Callahan
Carolann George
Gamal Jacob
Danvers Office:
F.J. Cassidy
Patrick Cranney
Janet Nichols
Marie Stanley
Jennifer Desimone
Debra Thomas-Savage Bob Cook
Russ Fravel