www.minerfamilyinsurance.com
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199.34.228.69
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Submitted URL: http://minerfamilyinsurance.com/motorcycle-quote.html
Effective URL: https://www.minerfamilyinsurance.com/motorcycle-quote.html
Submission: On October 29 via api from US — Scanned from DE
Effective URL: https://www.minerfamilyinsurance.com/motorcycle-quote.html
Submission: On October 29 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST //www.weebly.com/weebly/apps/formSubmitAjax.php
<form enctype="multipart/form-data" action="//www.weebly.com/weebly/apps/formSubmitAjax.php" method="POST" id="form-421155187257431690" accept-charset="UTF-8" target="form-421155187257431690-target-1730160812439">
<div id="421155187257431690-form-parent" class="wsite-form-container" style="margin-top:10px;">
<ul class="formlist" id="421155187257431690-form-list">
<h2 class="wsite-content-title" style="text-align:center;">
<font size="7">Vehicle Information<br>​</font>
</h2>
<label class="wsite-form-label wsite-form-fields-required-label"><span class="form-required">*</span> Indicates required field</label>
<div>
<div class="wsite-multicol">
<div class="wsite-multicol-table-wrap" style="margin:0 -15px;">
<table class="wsite-multicol-table">
<tbody class="wsite-multicol-tbody">
<tr class="wsite-multicol-tr">
<td class="wsite-multicol-col" style="width:50%; padding:0 15px;">
<div>
<div class="wsite-image wsite-image-border-none " style="padding-top:10px;padding-bottom:10px;margin-left:0px;margin-right:0px;text-align:center">
<a>
<img src="/uploads/1/3/8/4/138486298/7600877_5_orig.png" alt="Primary Motorcycle - Motorcycle Insurance Quote" style="width:auto;max-width:100%">
</a>
<div style="display:block;font-size:90%"></div>
</div>
</div>
<h2 class="wsite-content-title" style="text-align:left;">
<font size="4">Primary Motorcycle:</font>
</h2>
<div>
<div class="wsite-multicol">
<div class="wsite-multicol-table-wrap" style="margin:0 -15px;">
<table class="wsite-multicol-table">
<tbody class="wsite-multicol-tbody">
<tr class="wsite-multicol-tr">
<td class="wsite-multicol-col" style="width:29.004329004329%; padding:0 15px;">
<div>
<div class="wsite-form-field" style="margin:0px 0px 0px 0px;">
<label class="wsite-form-label" for="input-405515456468325650">Year <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-input-container">
<input aria-required="true" id="input-405515456468325650" class="wsite-form-input wsite-input wsite-input-width-100px" type="text" name="_u405515456468325650">
</div>
<div id="instructions-405515456468325650" class="wsite-form-instructions" style="display:none;">The year of the vehicle you'd like to insure. If you're not sure please make an estimate.</div>
</div>
</div>
</td>
<td class="wsite-multicol-col" style="width:28.65880297073%; padding:0 15px;">
<div>
<div class="wsite-form-field" style="margin:0px 0px 0px 0px;">
<label class="wsite-form-label" for="input-139695220641240653">Make <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-input-container">
<input aria-required="true" id="input-139695220641240653" class="wsite-form-input wsite-input wsite-input-width-100px" type="text" name="_u139695220641240653">
</div>
<div id="instructions-139695220641240653" class="wsite-form-instructions" style="display:none;">The company that makes your car. (i.e. Ford, Chevy, Tesla, etc.)</div>
</div>
</div>
</td>
<td class="wsite-multicol-col" style="width:42.336868024941%; padding:0 15px;">
<div>
<div class="wsite-form-field" style="margin:0px 0px 0px 0px;">
<label class="wsite-form-label" for="input-240889565585127629">Model <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-input-container">
<input aria-required="true" id="input-240889565585127629" class="wsite-form-input wsite-input wsite-input-width-370px" type="text" name="_u240889565585127629">
</div>
<div id="instructions-240889565585127629" class="wsite-form-instructions" style="display:none;">The model name of your vehicle. (i.e. Accord, Camry, F150, etc.)</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<div>
<div class="wsite-multicol">
<div class="wsite-multicol-table-wrap" style="margin:0 -15px;">
<table class="wsite-multicol-table">
<tbody class="wsite-multicol-tbody">
<tr class="wsite-multicol-tr">
<td class="wsite-multicol-col" style="width:50%; padding:0 15px;">
<div>
<div class="wsite-form-field" style="margin:0px 0px 0px 0px;">
<label class="wsite-form-label" for="input-593545230184973698">Drive to Work/School? <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-radio-container">
<select id="input-593545230184973698" name="_u593545230184973698" class="form-select" aria-required="true">
<option value="No">No</option>
<option value="Yes">Yes</option>
</select>
</div>
<div id="instructions-Drive to Work/School?" class="wsite-form-instructions" style="display:none;">Do you use this vehicle regularly to drive to and from work or school?</div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:5px 0px 0px 0px;">
<label class="wsite-form-label" for="input-222727880705042260">Work/School Distance <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-radio-container">
<select id="input-222727880705042260" name="_u222727880705042260" class="form-select" aria-required="true">
<option value="Less than 5 Miles">Less than 5 Miles</option>
<option value="5 Miles">5 Miles</option>
<option value="10 Miles">10 Miles</option>
<option value="15 MIles">15 MIles</option>
<option value="20 Miles">20 Miles</option>
<option value="30 Miles">30 Miles</option>
<option value="Over 30 Miles">Over 30 Miles</option>
<option value="N/A">N/A</option>
</select>
</div>
<div id="instructions-Work/School Distance" class="wsite-form-instructions" style="display:none;">The distance from your home to your regular place of work or school.</div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:0px 0px 0px 0px;">
<label class="wsite-form-label" for="input-307211837174684943">Annual Mileage <span class="form-required">*</span></label>
<div class="wsite-form-radio-container">
<select id="input-307211837174684943" name="_u307211837174684943" class="form-select" aria-required="true">
<option value="5,000">5,000</option>
<option value="7,500">7,500</option>
<option value="10,000">10,000</option>
<option value="12,500">12,500</option>
<option value="15,000">15,000</option>
<option value="20,000">20,000</option>
<option value="25,000">25,000</option>
<option value="30,000">30,000</option>
<option value="40,000">40,000</option>
<option value="50,000+">50,000+</option>
</select>
</div>
<div id="instructions-Annual Mileage" class="wsite-form-instructions" style="display:none;"></div>
</div>
</div>
</td>
<td class="wsite-multicol-col" style="width:50%; padding:0 15px;">
<div>
<div class="wsite-form-field" style="margin:0px 0px 0px 0px;">
<label class="wsite-form-label" for="input-496018148360899937">Is Motorcycle Leased? <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-radio-container">
<select id="input-496018148360899937" name="_u496018148360899937" class="form-select" aria-required="true">
<option value="No">No</option>
<option value="Yes">Yes</option>
</select>
</div>
<div id="instructions-Is Motorcycle Leased?" class="wsite-form-instructions" style="display:none;">Is the vehicle under a lease and you'll return it after the contract is over?</div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:5px 0px 0px 0px;">
<label class="wsite-form-label" for="input-231015224262590653">Collision Deductible <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-radio-container">
<select id="input-231015224262590653" name="_u231015224262590653" class="form-select" aria-required="true">
<option value="No Coverage">No Coverage</option>
<option value="$100">$100</option>
<option value="$250">$250</option>
<option value="$500">$500</option>
<option value="$1000">$1000</option>
</select>
</div>
<div id="instructions-Collision Deductible" class="wsite-form-instructions" style="display:none;">Collision coverage pays for damage to your vehicle regardless of fault. The deductible is what you pay before the
insurance company pays.</div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:0px 0px 0px 0px;">
<label class="wsite-form-label" for="input-541893934771025209">Comprehensive Deduct <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-radio-container">
<select id="input-541893934771025209" name="_u541893934771025209" class="form-select" aria-required="true">
<option value="No Coverage">No Coverage</option>
<option value="$100">$100</option>
<option value="$250">$250</option>
<option value="$500">$500</option>
<option value="$1000">$1000</option>
</select>
</div>
<div id="instructions-Comprehensive Deduct" class="wsite-form-instructions" style="display:none;">Comprehensive coverage pays for damage to or loss of your vehicle that doesn't involve a collision like weather,
vandalism, or theft. The deductible is what you pay before the insurance company pays.</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</td>
<td class="wsite-multicol-col" style="width:50%; padding:0 15px;">
<div>
<div class="wsite-image wsite-image-border-none " style="padding-top:10px;padding-bottom:10px;margin-left:0px;margin-right:0px;text-align:center">
<a>
<img src="/uploads/1/3/8/4/138486298/7617720_5_orig.png" alt="Additional Motorcycles Motorcycle Insurance Quote" style="width:auto;max-width:100%">
</a>
<div style="display:block;font-size:90%"></div>
</div>
</div>
<h2 class="wsite-content-title" style="text-align:left;">
<font size="4">Motorcycle #2 (if necessary)</font>
</h2>
<div>
<div class="wsite-multicol">
<div class="wsite-multicol-table-wrap" style="margin:0 -15px;">
<table class="wsite-multicol-table">
<tbody class="wsite-multicol-tbody">
<tr class="wsite-multicol-tr">
<td class="wsite-multicol-col" style="width:29.004329004329%; padding:0 15px;">
<div>
<div class="wsite-form-field" style="margin:0px 0px 0px 0px;">
<label class="wsite-form-label" for="input-976522983157928959">Year (M2) <span class="form-not-required">*</span></label>
<div class="wsite-form-input-container">
<input id="input-976522983157928959" class="wsite-form-input wsite-input wsite-input-width-100px" type="text" name="_u976522983157928959">
</div>
<div id="instructions-976522983157928959" class="wsite-form-instructions" style="display:none;"></div>
</div>
</div>
</td>
<td class="wsite-multicol-col" style="width:28.65880297073%; padding:0 15px;">
<div>
<div class="wsite-form-field" style="margin:0px 0px 0px 0px;">
<label class="wsite-form-label" for="input-575139893375458227">Make (M2) <span class="form-not-required">*</span></label>
<div class="wsite-form-input-container">
<input id="input-575139893375458227" class="wsite-form-input wsite-input wsite-input-width-100px" type="text" name="_u575139893375458227">
</div>
<div id="instructions-575139893375458227" class="wsite-form-instructions" style="display:none;"></div>
</div>
</div>
</td>
<td class="wsite-multicol-col" style="width:42.336868024941%; padding:0 15px;">
<div>
<div class="wsite-form-field" style="margin:0px 0px 0px 0px;">
<label class="wsite-form-label" for="input-398319528515122821">Model (M2) <span class="form-not-required">*</span></label>
<div class="wsite-form-input-container">
<input id="input-398319528515122821" class="wsite-form-input wsite-input wsite-input-width-370px" type="text" name="_u398319528515122821">
</div>
<div id="instructions-398319528515122821" class="wsite-form-instructions" style="display:none;"></div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<div>
<div class="wsite-multicol">
<div class="wsite-multicol-table-wrap" style="margin:0 -15px;">
<table class="wsite-multicol-table">
<tbody class="wsite-multicol-tbody">
<tr class="wsite-multicol-tr">
<td class="wsite-multicol-col" style="width:50%; padding:0 15px;">
<div>
<div class="wsite-form-field" style="margin:0px 0px 0px 0px;">
<label class="wsite-form-label" for="input-815071058643965669">Used for Commute? (M2) <span class="form-not-required">*</span></label>
<div class="wsite-form-radio-container">
<select id="input-815071058643965669" name="_u815071058643965669" class="form-select">
<option value="-">-</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</div>
<div id="instructions-Used for Commute? (M2)" class="wsite-form-instructions" style="display:none;"></div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:5px 0px 0px 0px;">
<label class="wsite-form-label" for="input-752390466610533398">Commute Distance (M2) <span class="form-not-required">*</span></label>
<div class="wsite-form-radio-container">
<select id="input-752390466610533398" name="_u752390466610533398" class="form-select">
<option value="-">-</option>
<option value="Less than 5 Miles">Less than 5 Miles</option>
<option value="5 Miles">5 Miles</option>
<option value="10 Miles">10 Miles</option>
<option value="15 MIles">15 MIles</option>
<option value="20 Miles">20 Miles</option>
<option value="30 Miles">30 Miles</option>
<option value="Over 30 Miles">Over 30 Miles</option>
<option value="N/A">N/A</option>
</select>
</div>
<div id="instructions-Commute Distance (M2)" class="wsite-form-instructions" style="display:none;"></div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:0px 0px 0px 0px;">
<label class="wsite-form-label" for="input-278903070248685625">Annual Mileage (M2) <span class="form-not-required">*</span></label>
<div class="wsite-form-radio-container">
<select id="input-278903070248685625" name="_u278903070248685625" class="form-select">
<option value="-">-</option>
<option value="5,000">5,000</option>
<option value="7,500">7,500</option>
<option value="10,000">10,000</option>
<option value="12,500">12,500</option>
<option value="15,000">15,000</option>
<option value="20,000">20,000</option>
<option value="25,000">25,000</option>
<option value="30,000">30,000</option>
<option value="40,000">40,000</option>
<option value="50,000+">50,000+</option>
</select>
</div>
<div id="instructions-Annual Mileage (M2)" class="wsite-form-instructions" style="display:none;"></div>
</div>
</div>
</td>
<td class="wsite-multicol-col" style="width:50%; padding:0 15px;">
<div>
<div class="wsite-form-field" style="margin:0px 0px 0px 0px;">
<label class="wsite-form-label" for="input-214908153368185270">Is Motorcycle Leased? (M2) <span class="form-not-required">*</span></label>
<div class="wsite-form-radio-container">
<select id="input-214908153368185270" name="_u214908153368185270" class="form-select">
<option value="-">-</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</div>
<div id="instructions-Is Motorcycle Leased? (M2)" class="wsite-form-instructions" style="display:none;"></div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:5px 0px 0px 0px;">
<label class="wsite-form-label" for="input-753983826451762398">Collision Deduct. (M2) <span class="form-not-required">*</span></label>
<div class="wsite-form-radio-container">
<select id="input-753983826451762398" name="_u753983826451762398" class="form-select">
<option value="-">-</option>
<option value="$100">$100</option>
<option value="$250">$250</option>
<option value="$500">$500</option>
<option value="$1000">$1000</option>
<option value="No Coverage">No Coverage</option>
</select>
</div>
<div id="instructions-Collision Deduct. (M2)" class="wsite-form-instructions" style="display:none;"></div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:0px 0px 0px 0px;">
<label class="wsite-form-label" for="input-363168452870485679">Comp Deductible (M2) <span class="form-not-required">*</span></label>
<div class="wsite-form-radio-container">
<select id="input-363168452870485679" name="_u363168452870485679" class="form-select">
<option value="-">-</option>
<option value="$100">$100</option>
<option value="$250">$250</option>
<option value="$500">$500</option>
<option value="$1000">$1000</option>
<option value="No Coverage">No Coverage</option>
</select>
</div>
<div id="instructions-Comp Deductible (M2)" class="wsite-form-instructions" style="display:none;"></div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<div>
<div style="height: 20px; overflow: hidden; width: 100%;"></div>
<hr class="styled-hr" style="width:100%;">
<div style="height: 20px; overflow: hidden; width: 100%;"></div>
</div>
<div>
<div class="wsite-form-field" style="margin:5px 0px 0px 0px;">
<label class="wsite-form-label" for="input-366239188763939135">Do you have more than 2 motorcycles to insure? <span class="form-required">*</span></label>
<div class="wsite-form-radio-container">
<select id="input-366239188763939135" name="_u366239188763939135" class="form-select" aria-required="true">
<option value="No">No</option>
<option value="Yes - 4 Total">Yes - 4 Total</option>
<option value="Yes - 5 Total">Yes - 5 Total</option>
<option value="Yes - 6 Total">Yes - 6 Total</option>
<option value="Yes - 7 Total">Yes - 7 Total</option>
<option value="Yes - 8+ Total">Yes - 8+ Total</option>
</select>
</div>
<div id="instructions-Do you have more than 2 motorcycles to insure?" class="wsite-form-instructions" style="display:none;"></div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<div>
<div style="height: 20px; overflow: hidden; width: 100%;"></div>
<hr class="styled-hr" style="width:100%;">
<div style="height: 20px; overflow: hidden; width: 100%;"></div>
</div>
<h2 class="wsite-content-title" style="text-align:center;">
<font size="7">Operator Information<br>​</font>
</h2>
<div>
<div class="wsite-multicol">
<div class="wsite-multicol-table-wrap" style="margin:0 -15px;">
<table class="wsite-multicol-table">
<tbody class="wsite-multicol-tbody">
<tr class="wsite-multicol-tr">
<td class="wsite-multicol-col" style="width:50%; padding:0 15px;">
<div>
<div class="wsite-image wsite-image-border-none " style="padding-top:10px;padding-bottom:10px;margin-left:0px;margin-right:0px;text-align:center">
<a>
<img src="/uploads/1/3/8/4/138486298/1223950_5_orig.png" alt="Primary Rider Motorcycle Insurance Quote" style="width:auto;max-width:100%">
</a>
<div style="display:block;font-size:90%"></div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:5px 0px 5px 0px;">
<label class="wsite-form-label" for="input-760099984204841671">Primary Operator Name <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-input-container">
<input aria-required="true" id="input-760099984204841671" class="wsite-form-input wsite-input wsite-input-width-370px" type="text" name="_u760099984204841671">
</div>
<div id="instructions-760099984204841671" class="wsite-form-instructions" style="display:none;">Please enter the first and last name of the primary operator of the vehicle.</div>
</div>
</div>
<div>
<div class="wsite-multicol">
<div class="wsite-multicol-table-wrap" style="margin:0 -15px;">
<table class="wsite-multicol-table">
<tbody class="wsite-multicol-tbody">
<tr class="wsite-multicol-tr">
<td class="wsite-multicol-col" style="width:50%; padding:0 15px;">
<div>
<div class="wsite-form-field" style="margin:5px 0px 0px 0px;">
<label class="wsite-form-label" for="input-796854817595276639">Gender <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-radio-container">
<select id="input-796854817595276639" name="_u796854817595276639" class="form-select" aria-required="true">
<option value="Male">Male</option>
<option value="Female">Female</option>
<option value="n/a">n/a</option>
</select>
</div>
<div id="instructions-Gender" class="wsite-form-instructions" style="display:none;">Please choose the gender of this operator.</div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:5px 0px 5px 0px;">
<label class="wsite-form-label" for="input-299993056691640779">Date of Birth <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-input-container">
<input aria-required="true" id="input-299993056691640779" class="wsite-form-input wsite-input wsite-input-width-370px" type="text" name="_u299993056691640779">
</div>
<div id="instructions-299993056691640779" class="wsite-form-instructions" style="display:none;">The Date of Birth of this individual in the following format: MM/DD/YYYY</div>
</div>
</div>
</td>
<td class="wsite-multicol-col" style="width:50%; padding:0 15px;">
<div>
<div class="wsite-form-field" style="margin:5px 0px 0px 0px;">
<label class="wsite-form-label" for="input-415201960869928770">Married? <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-radio-container">
<select id="input-415201960869928770" name="_u415201960869928770" class="form-select" aria-required="true">
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</div>
<div id="instructions-Married?" class="wsite-form-instructions" style="display:none;">Is this person currently legally married?</div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:5px 0px 0px 0px;">
<label class="wsite-form-label" for="input-835393549599601343">Status <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-radio-container">
<select id="input-835393549599601343" name="_u835393549599601343" class="form-select" aria-required="true">
<option value="Employed">Employed</option>
<option value="Student">Student</option>
<option value="Retired">Retired</option>
<option value="Other">Other</option>
</select>
</div>
<div id="instructions-Status" class="wsite-form-instructions" style="display:none;">Please select this person's current work/school status.</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</td>
<td class="wsite-multicol-col" style="width:50%; padding:0 15px;">
<div>
<div class="wsite-image wsite-image-border-none " style="padding-top:10px;padding-bottom:10px;margin-left:0px;margin-right:0px;text-align:center">
<a>
<img src="/uploads/1/3/8/4/138486298/8499761_5_orig.png" alt="Additional Operator Motorcycle Insurance Quote" style="width:auto;max-width:100%">
</a>
<div style="display:block;font-size:90%"></div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:5px 0px 5px 0px;">
<label class="wsite-form-label" for="input-678076935595592191">Operator 2 Name (if necessary) <span class="form-not-required">*</span></label>
<div class="wsite-form-input-container">
<input id="input-678076935595592191" class="wsite-form-input wsite-input wsite-input-width-370px" type="text" name="_u678076935595592191">
</div>
<div id="instructions-678076935595592191" class="wsite-form-instructions" style="display:none;"></div>
</div>
</div>
<div>
<div class="wsite-multicol">
<div class="wsite-multicol-table-wrap" style="margin:0 -15px;">
<table class="wsite-multicol-table">
<tbody class="wsite-multicol-tbody">
<tr class="wsite-multicol-tr">
<td class="wsite-multicol-col" style="width:50%; padding:0 15px;">
<div>
<div class="wsite-form-field" style="margin:5px 0px 0px 0px;">
<label class="wsite-form-label" for="input-414473746415942567">Gender (O2) <span class="form-not-required">*</span></label>
<div class="wsite-form-radio-container">
<select id="input-414473746415942567" name="_u414473746415942567" class="form-select">
<option value="-">-</option>
<option value="Male">Male</option>
<option value="Female">Female</option>
<option value="n/a">n/a</option>
</select>
</div>
<div id="instructions-Gender (O2)" class="wsite-form-instructions" style="display:none;"></div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:5px 0px 5px 0px;">
<label class="wsite-form-label" for="input-888547394468277514">Date of Birth (O2) <span class="form-not-required">*</span></label>
<div class="wsite-form-input-container">
<input id="input-888547394468277514" class="wsite-form-input wsite-input wsite-input-width-370px" type="text" name="_u888547394468277514">
</div>
<div id="instructions-888547394468277514" class="wsite-form-instructions" style="display:none;"></div>
</div>
</div>
</td>
<td class="wsite-multicol-col" style="width:50%; padding:0 15px;">
<div>
<div class="wsite-form-field" style="margin:5px 0px 0px 0px;">
<label class="wsite-form-label" for="input-215792589772159762">Married? (O2) <span class="form-not-required">*</span></label>
<div class="wsite-form-radio-container">
<select id="input-215792589772159762" name="_u215792589772159762" class="form-select">
<option value="-">-</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</div>
<div id="instructions-Married? (O2)" class="wsite-form-instructions" style="display:none;"></div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:5px 0px 0px 0px;">
<label class="wsite-form-label" for="input-183775835141528936">Status (O2) <span class="form-not-required">*</span></label>
<div class="wsite-form-radio-container">
<select id="input-183775835141528936" name="_u183775835141528936" class="form-select">
<option value="-">-</option>
<option value="Employed">Employed</option>
<option value="Student">Student</option>
<option value="Retired">Retired</option>
<option value="Other">Other</option>
</select>
</div>
<div id="instructions-Status (O2)" class="wsite-form-instructions" style="display:none;"></div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<div>
<div style="height: 20px; overflow: hidden; width: 100%;"></div>
<hr class="styled-hr" style="width:100%;">
<div style="height: 20px; overflow: hidden; width: 100%;"></div>
</div>
<h2 class="wsite-content-title" style="text-align:center;">
<font size="7">Additional Information<br>​</font><br>
</h2>
<div>
<div class="wsite-multicol">
<div class="wsite-multicol-table-wrap" style="margin:0 -15px;">
<table class="wsite-multicol-table">
<tbody class="wsite-multicol-tbody">
<tr class="wsite-multicol-tr">
<td class="wsite-multicol-col" style="width:50%; padding:0 15px;">
<div>
<div class="wsite-form-field wsite-name-field" style="margin:5px 0px 5px 0px;">
<label class="wsite-form-label">Name <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div style="clear:both;"></div>
<div class="wsite-form-input-container wsite-form-left wsite-form-input-first-name">
<input aria-required="true" id="input-736805124104963250" class="wsite-form-input wsite-input" placeholder="First" type="text" name="_u736805124104963250[first]">
<label class="wsite-form-sublabel" for="input-736805124104963250">First</label>
</div>
<div class="wsite-form-input-container wsite-form-right wsite-form-input-last-name">
<input aria-required="true" id="input-736805124104963250-1" class="wsite-form-input wsite-input" placeholder="Last" type="text" name="_u736805124104963250[last]">
<label class="wsite-form-sublabel" for="input-736805124104963250-1">Last</label>
</div>
<div id="instructions-736805124104963250" class="wsite-form-instructions" style="display:none;">The legal name of the person who owns the vehicles and will be the primary named person on the insurance policy.</div>
</div>
<div style="clear:both;"></div>
</div>
<div>
<div class="wsite-form-field wsite-address-field" style="margin:5px 0px 5px 0px;">
<label class="wsite-form-label">Address <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-input-container">
<input id="input-981821225213024488" class="wsite-form-input wsite-input" placeholder="Line 1" type="text" name="_u981821225213024488[line1]" aria-required="true">
<label class="wsite-form-sublabel" for="input-981821225213024488">Line 1</label>
</div>
<div class="wsite-form-input-container">
<input id="input-981821225213024488-1" class="wsite-form-input" type="text" placeholder="Line 2" name="_u981821225213024488[line2]" aria-required="false">
<label class="wsite-form-sublabel" for="input-981821225213024488-1">Line 2</label>
</div>
<div class="wsite-form-input-container wsite-form-left wsite-address-short">
<input id="input-981821225213024488-2" class="wsite-form-input" type="text" placeholder="City" name="_u981821225213024488[city]" aria-required="true">
<label class="wsite-form-sublabel" for="input-981821225213024488-2">City</label>
</div>
<div class="wsite-form-input-container wsite-form-right wsite-address-short">
<input id="input-981821225213024488-3" class="wsite-form-input" type="text" placeholder="State" name="_u981821225213024488[state]" aria-required="true">
<label class="wsite-form-sublabel" for="input-981821225213024488-3">State</label>
</div>
<div class="wsite-form-input-container wsite-form-left wsite-address-short">
<input id="input-981821225213024488-4" class="wsite-form-input" type="text" placeholder="Zip Code" name="_u981821225213024488[zip]" aria-required="true">
<label class="wsite-form-sublabel" for="input-981821225213024488-4">Zip Code</label>
</div>
<div class="wsite-form-input-container wsite-form-right wsite-form-element-country wsite-address-short">
<input id="input-981821225213024488-5" class="wsite-form-input" type="text" placeholder="Country" name="_u981821225213024488[country]" aria-required="true">
<label class="wsite-form-sublabel" for="input-981821225213024488-5">Country</label>
</div>
<div id="instructions-981821225213024488" class="wsite-form-instructions" style="display:none;">Please enter your mailing address.</div>
</div>
<div style="clear:both;"></div>
</div>
<div>
<div class="wsite-form-field" style="margin:5px 0px 5px 0px;">
<label class="wsite-form-label" for="input-128837878189391161">Email <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-input-container">
<input aria-required="true" id="input-128837878189391161" class="wsite-form-input wsite-input wsite-input-width-370px" type="text" name="_u128837878189391161">
</div>
<div id="instructions-128837878189391161" class="wsite-form-instructions" style="display:none;">Please enter an email address where we can contact you.</div>
</div>
</div>
<div>
<div class="wsite-form-field wsite-phone-field" style="margin-top:5px;">
<label class="wsite-form-label" for="input-747287335643926884">Phone Number <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div style="clear:both;"></div>
<div class="wsite-form-input-container wsite-form-left" style="margin-bottom:5px;">
<input aria-required="true" id="input-747287335643926884" class="wsite-form-input wsite-input" type="text" name="_u747287335643926884[number]">
</div>
<div id="instructions-747287335643926884" class="wsite-form-instructions" style="display:none;">Please enter a phone number where we can contact you.</div>
</div>
<div style="clear:both;"></div>
</div>
<div>
<div id="322208328690156480" align="left" style="width: 100%; overflow-y: hidden;" class="wcustomhtml">
<div class="wsite-form-field" style="margin:10px 0 0 0;">
<label class="wsite-form-label">🔒 Your information is secure.<span class="wsite-instructions-help"></span></label>
<div class="wsite-form-instructions" style="display:none;">Your private information is provided exclusively to our agency and will not be redistributed or sold to anyone else.</div>
</div>
</div>
</div>
</td>
<td class="wsite-multicol-col" style="width:50%; padding:0 15px;">
<div>
<div class="wsite-form-field" style="margin:5px 0px 5px 0px;">
<label class="wsite-form-label" for="input-494019006635030595">Current or Prior Insurance Company <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-input-container">
<input aria-required="true" id="input-494019006635030595" class="wsite-form-input wsite-input wsite-input-width-370px" type="text" name="_u494019006635030595">
</div>
<div id="instructions-494019006635030595" class="wsite-form-instructions" style="display:none;">Please enter the name of your current insurance company. If you're not currently insured leave this field blank.</div>
</div>
</div>
<div>
<div class="wsite-multicol">
<div class="wsite-multicol-table-wrap" style="margin:0 -15px;">
<table class="wsite-multicol-table">
<tbody class="wsite-multicol-tbody">
<tr class="wsite-multicol-tr">
<td class="wsite-multicol-col" style="width:50%; padding:0 15px;">
<div>
<div class="wsite-form-field" style="margin:5px 0px 0px 0px;">
<label class="wsite-form-label" for="input-157533853540818057">Continuous Coverage <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-radio-container">
<select id="input-157533853540818057" name="_u157533853540818057" class="form-select" aria-required="true">
<option value="3+ Years">3+ Years</option>
<option value="2 Years">2 Years</option>
<option value="1 Year">1 Year</option>
<option value="6 Months">6 Months</option>
<option value="Under 6 Months">Under 6 Months</option>
<option value="Not Currently Insured">Not Currently Insured</option>
</select>
</div>
<div id="instructions-Continuous Coverage" class="wsite-form-instructions" style="display:none;">How long have you been continually covered with a liability insurance policy?</div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:5px 0px 0px 0px;">
<label class="wsite-form-label" for="input-273309563240463524">Claims in 3 Years <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-radio-container">
<select id="input-273309563240463524" name="_u273309563240463524" class="form-select" aria-required="true">
<option value="None">None</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4+">4+</option>
</select>
</div>
<div id="instructions-Claims in 3 Years" class="wsite-form-instructions" style="display:none;">Please enter the number of insurance claims you've had for this type of insurance in the past 3 years.</div>
</div>
</div>
</td>
<td class="wsite-multicol-col" style="width:50%; padding:0 15px;">
<div>
<div class="wsite-form-field" style="margin:5px 0px 0px 0px;">
<label class="wsite-form-label" for="input-946706601197547173">Policy Expires In <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-radio-container">
<select id="input-946706601197547173" name="_u946706601197547173" class="form-select" aria-required="true">
<option value="Not Sure">Not Sure</option>
<option value="A few days">A few days</option>
<option value="2 weeks">2 weeks</option>
<option value="1 month">1 month</option>
<option value="2 months">2 months</option>
<option value="3 months">3 months</option>
<option value="3-6 months">3-6 months</option>
<option value="6+ months">6+ months</option>
</select>
</div>
<div id="instructions-Policy Expires In" class="wsite-form-instructions" style="display:none;">When does your current policy expire?</div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:5px 0px 0px 0px;">
<label class="wsite-form-label" for="input-940850700237225307">Tickets in 3 Years <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-radio-container">
<select id="input-940850700237225307" name="_u940850700237225307" class="form-select" aria-required="true">
<option value="None">None</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6+">6+</option>
</select>
</div>
<div id="instructions-Tickets in 3 Years" class="wsite-form-instructions" style="display:none;">Please select the number of traffic violations for all listed operators that will show up on a motor vehicle report.
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:5px 0px 0px 0px;">
<label class="wsite-form-label" for="input-623903907776118956">Coverage Desired <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-radio-container">
<select id="input-623903907776118956" name="_u623903907776118956" class="form-select" aria-required="true">
<option value="Standard Coverage">Standard Coverage</option>
<option value="Premium Coverage">Premium Coverage</option>
<option value="State Minimum">State Minimum</option>
</select>
</div>
<div id="instructions-Coverage Desired" class="wsite-form-instructions" style="display:none;">Please select the degree of liability coverage you would like. If you're not sure please select "Standard Coverage".</div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:5px 0px 5px 0px;">
<label class="wsite-form-label" for="input-860428553253385129">When would you like this policy to start? <span class="form-required">*</span></label>
<div class="wsite-form-input-container">
<input aria-required="true" id="input-860428553253385129" class="wsite-form-input wsite-input wsite-input-width-370px" type="text" name="_u860428553253385129">
</div>
<div id="instructions-860428553253385129" class="wsite-form-instructions" style="display:none;"></div>
</div>
</div>
<div>
<div class="wsite-form-field" style="margin:5px 0px 5px 0px;">
<label class="wsite-form-label" for="input-362075059880900840">Message <span class="form-required">*</span><span class="wsite-instructions-help"></span></label>
<div class="wsite-form-input-container">
<textarea aria-required="true" id="input-362075059880900840" class="wsite-form-input wsite-input wsite-input-width-370px" name="_u362075059880900840" style="height: 50px"></textarea>
</div>
<div id="instructions-362075059880900840" class="wsite-form-instructions" style="display:none;">Is there anything else we should know about?</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</ul>
</div>
<div style="display:none; visibility:hidden;">
<input type="hidden" name="wsite_subject">
</div>
<div style="text-align:left; margin-top:10px; margin-bottom:10px;">
<input type="hidden" name="form_version" value="2">
<input type="hidden" name="wsite_approved" id="wsite-approved" value="approved">
<input type="hidden" name="ucfid" value="421155187257431690">
<input type="hidden" name="recaptcha_token">
<input type="submit" role="button" aria-label="Get QUOTE" value="Get QUOTE" style="position:absolute;top:0;left:-9999px;width:1px;height:1px">
<a class="wsite-button">
<span class="wsite-button-inner">Get QUOTE</span>
</a>
</div>
<input type="hidden" id="formLocation" name="formLocation" value="www.minerfamilyinsurance.com">
</form>Text Content
ALREADY INSURED? COMPARE YOUR RATES: Â Â COMPARE MY INSURANCE
* Home
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MOTORCYCLE QUOTE
COMPLETE THE DETAILS BELOW TO GET YOUR FREE MOTORCYCLE INSURANCE QUOTE
Contact us
Quick Quote
VEHICLE INFORMATION
* Indicates required field
PRIMARY MOTORCYCLE:
Year *
The year of the vehicle you'd like to insure. If you're not sure please make an
estimate.
Make *
The company that makes your car. (i.e. Ford, Chevy, Tesla, etc.)
Model *
The model name of your vehicle. (i.e. Accord, Camry, F150, etc.)
Drive to Work/School? *
No Yes
Do you use this vehicle regularly to drive to and from work or school?
Work/School Distance *
Less than 5 Miles 5 Miles 10 Miles 15 MIles 20 Miles 30 Miles Over 30 Miles N/A
The distance from your home to your regular place of work or school.
Annual Mileage *
5,000 7,500 10,000 12,500 15,000 20,000 25,000 30,000 40,000 50,000+
Is Motorcycle Leased? *
No Yes
Is the vehicle under a lease and you'll return it after the contract is over?
Collision Deductible *
No Coverage $100 $250 $500 $1000
Collision coverage pays for damage to your vehicle regardless of fault. The
deductible is what you pay before the insurance company pays.
Comprehensive Deduct *
No Coverage $100 $250 $500 $1000
Comprehensive coverage pays for damage to or loss of your vehicle that doesn't
involve a collision like weather, vandalism, or theft. The deductible is what
you pay before the insurance company pays.
MOTORCYCLE #2 (IF NECESSARY)
Year (M2) *
Make (M2) *
Model (M2) *
Used for Commute? (M2) *
- Yes No
Commute Distance (M2) *
- Less than 5 Miles 5 Miles 10 Miles 15 MIles 20 Miles 30 Miles Over 30 Miles
N/A
Annual Mileage (M2) *
- 5,000 7,500 10,000 12,500 15,000 20,000 25,000 30,000 40,000 50,000+
Is Motorcycle Leased? (M2) *
- Yes No
Collision Deduct. (M2) *
- $100 $250 $500 $1000 No Coverage
Comp Deductible (M2) *
- $100 $250 $500 $1000 No Coverage
--------------------------------------------------------------------------------
Do you have more than 2 motorcycles to insure? *
No Yes - 4 Total Yes - 5 Total Yes - 6 Total Yes - 7 Total Yes - 8+ Total
--------------------------------------------------------------------------------
OPERATOR INFORMATION
Primary Operator Name *
Please enter the first and last name of the primary operator of the vehicle.
Gender *
Male Female n/a
Please choose the gender of this operator.
Date of Birth *
The Date of Birth of this individual in the following format: MM/DD/YYYY
Married? *
Yes No
Is this person currently legally married?
Status *
Employed Student Retired Other
Please select this person's current work/school status.
Operator 2 Name (if necessary) *
Gender (O2) *
- Male Female n/a
Date of Birth (O2) *
Married? (O2) *
- Yes No
Status (O2) *
- Employed Student Retired Other
--------------------------------------------------------------------------------
ADDITIONAL INFORMATION
Name *
First
Last
The legal name of the person who owns the vehicles and will be the primary named
person on the insurance policy.
Address *
Line 1
Line 2
City
State
Zip Code
Country
Please enter your mailing address.
Email *
Please enter an email address where we can contact you.
Phone Number *
Please enter a phone number where we can contact you.
🔒 Your information is secure.
Your private information is provided exclusively to our agency and will not be
redistributed or sold to anyone else.
Current or Prior Insurance Company *
Please enter the name of your current insurance company. If you're not currently
insured leave this field blank.
Continuous Coverage *
3+ Years 2 Years 1 Year 6 Months Under 6 Months Not Currently Insured
How long have you been continually covered with a liability insurance policy?
Claims in 3 Years *
None 1 2 3 4+
Please enter the number of insurance claims you've had for this type of
insurance in the past 3 years.
Policy Expires In *
Not Sure A few days 2 weeks 1 month 2 months 3 months 3-6 months 6+ months
When does your current policy expire?
Tickets in 3 Years *
None 1 2 3 4 5 6+
Please select the number of traffic violations for all listed operators that
will show up on a motor vehicle report.
Coverage Desired *
Standard Coverage Premium Coverage State Minimum
Please select the degree of liability coverage you would like. If you're not
sure please select "Standard Coverage".
When would you like this policy to start? *
Message *
Is there anything else we should know about?
Get QUOTE
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Miner Family Insurance
3209 S Broadway
Suite 229
Edmond, OK 73013
(405) 724-2389
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The year of the vehicle you'd like to insure. If you're not sure please make an
estimate.
The company that makes your car. (i.e. Ford, Chevy, Tesla, etc.)
The model name of your vehicle. (i.e. Accord, Camry, F150, etc.)
Do you use this vehicle regularly to drive to and from work or school?
The distance from your home to your regular place of work or school.
Is the vehicle under a lease and you'll return it after the contract is over?
Collision coverage pays for damage to your vehicle regardless of fault. The
deductible is what you pay before the insurance company pays.
Comprehensive coverage pays for damage to or loss of your vehicle that doesn't
involve a collision like weather, vandalism, or theft. The deductible is what
you pay before the insurance company pays.
Please enter the first and last name of the primary operator of the vehicle.
Please choose the gender of this operator.
The Date of Birth of this individual in the following format: MM/DD/YYYY
Is this person currently legally married?
Please select this person's current work/school status.
The legal name of the person who owns the vehicles and will be the primary named
person on the insurance policy.
Please enter your mailing address.
Please enter an email address where we can contact you.
Please enter a phone number where we can contact you.
Your private information is provided exclusively to our agency and will not be
redistributed or sold to anyone else.
Please enter the name of your current insurance company. If you're not currently
insured leave this field blank.
How long have you been continually covered with a liability insurance policy?
Please enter the number of insurance claims you've had for this type of
insurance in the past 3 years.
When does your current policy expire?
Please select the number of traffic violations for all listed operators that
will show up on a motor vehicle report.
Please select the degree of liability coverage you would like. If you're not
sure please select "Standard Coverage".
Is there anything else we should know about?
* Auto Quotes >
* Auto Insurance Quote
* Motorcycle Quote
* RV Insurance Quote
* Classic Car Insurance Quote
* ATV Insurance Quote
* Property Quotes >
* Home Insurance Quote
* Landlords Insurance Quote
* Renters Insurance Quote
* Earthquake Insurance Quote
* Flood Insurance Quote
* Life & Financial Quotes >
* Life Insurance Quote
* Final Expense Insurance Quote
* Business Quotes >
* Business Insurance Quote
* Workers Compensation Quote
* Business Owners Package (BOP) Insurance Quote
* Health Insurance Quote
* Other Quotes >
* Boat Insurance Quote
* Event Insurance Quote
* Umbrella Insurance Quote
* Travel Insurance Quote
* Wedding Insurance Quote
* Vehicles >
* Auto Insurance
* ATV Insurance
* Classic Car Insurance
* Motorcycle Insurance
* RV Insurance
* Property >
* Home Insurance
* Earthquake Insurance
* Flood Insurance
* Landlords Insurance
* Renters Insurance
* Life/Financial >
* Life Insurance
* Final Expense Insurance
* Business >
* Business Insurance
* Business Owners Package (BOP) Insurance
* Insurance Bonds
* Workers Compensation
* Other >
* Boat Insurance
* Event Insurance
* Travel Insurance
* Wedding Insurance
* Umbrella Insurance
* Client Testimonials
* Refer a Friend
* Insurance Carriers
* Book An Appointment
* Accessibility Statement