Boat Insurance Quote

Boat Insurance Quote Request

Complete the following information if you would like to obtain a quote. Please understand this is not an application. An application will be sent to you if coverage is desired.

All information provided on this information sheet is confidential and will be used solely for the purpose of developing a quote for you.

Contact and General Information
*First Name
*Last Name
*Street Address
City/St/Zip
Phone Number
Alternate Number
*Email Address
Mailing Address - if different from above
Mailing Address

 
Operator 1 Information
First Name
Last Name
Gender  Male Female
Birthdate
Marital Status
Years of boating experience
State Licensed
Occupation
Operator 2 Information
First Name
Last Name
Gender  Male Female
Birthdate
Marital Status
Years of boating experience
State Licensed
Occupation
 
Boat Information
Year
Make
Model
Type
Identification Serial Number
Cost New Value
Hours Used Each Year
Boat Length
Watercraft Weight
Describe any accessories or special equipment including cost when new:
Ownership
Lienholder (if any)  
  Street Address:
  City:
  State:
  Zip Code:
Is the boat docked/stored at a Marina?  Yes No
  If yes, Marina name
 
Trailer Information
Year
Make
Model
Type (# of axles)
Cost New Value
Identification Serial Number
 
Motor Information
Year
Make
Model
Type (in/out)
Identification Serial Number
Cost New Value
Horsepower or Motor Size
Number of motors
 
Deductible Information
Boat
and Motor
Comp (theft)
Collision
Trailer
Comp (theft)
Collision
 
Violation Information - Last 3 years (minor violations) / Last 5 years (major violations)
Operator 1
Minor Violations - speeding, turn, stop sign, red light, etc.
Accidents - non chargeable
Accidents - chargeable
Major violations - drunk driving, reckless,hit and run, etc.
Operator 2
Minor Violations - speeding, turn, stop sign, red light, etc.
Accidents - non chargeable
Accidents - chargeable
Major violations - drunk driving, reckless,hit and run, etc.
 
Coverage Information
Personal Liability / Bodily Injury
Personal Liability / Property Damage
Uninsured Motorist / Bodily Injury
Uninsured Motorist / Property Damage
Medical Payment
 
Miscellaneous Information
Does the Boat have a Fire System?  Yes No
Is or will the boat be used in connection with any operator's business or profession?  Yes No
What is the Fuel Type?
What is the estimated annual hourly usage?
In which state is or will the boat be registered in?
Current Insurance Company
Expiration Date
Current Premium
Questions or Comments
 
Best Time To Contact You
Please let us know the best time to call and discuss your quote  Morning Afternoon Evening Anytime Or Specify Other:
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