Boat & Watercraft Insurance Quote Request




Effective Date:
Your Name:
Current Address: Street
Prior Address:
(If less than 2yrs at current address)
Street
City, State & Zip


City, State & Zip


Phone:
Please call me with quote premium.

Please send quote via e-mail.
Email:
 
Description
of Property:
     
Motor type:
Number of Engines:
Boat Type:
Other Boat Type
Fuel:
Maximum Speed:
Hull Material:
Other Hull Material:
 
Insured Watercraft:
Boat:  Year Manufacturer Model  Serial Number TotalHP Length







O/B Motor: Year Manufacturer Model  Serial Number TotalHP  
   
Trailer:
Year  Manufacturer     Serial Number    
       
Is the boat chartered or used for other than private pleasure purposes?
Yes
   No
 
Coverage:   Limits: Optional Coverages:
Boat
(incl. aux
equip)


Agreed Value Endorsement

Actual Cash Value

Fishing Equipment Limit:  

O/B Motor 1. 
(ACV Coverage)
O/B Motor 2. 
(ACV Coverage)
Boat Trailer 

Pers. Property 
($500 Automatic)
Towing 
($400 Automatic)
Boat Liability

Medical Payments 
($1000 Automatic)
Uninsured Boater

 
Safety Equipment:

GPS

Automatic CO2 (Halon)

Ship to Shore Radio (VHF)

Depth Sounder

Electronic Burglar Alarm


Radar

Plotter

EPIRB

Vapor Detector Alarm
 
Operator Information:
DOB:
Years of experience:
Waters to be
Navigated:
 
Inland waters of the
following states:
Coastal waters of the
following states:
Previous Loss Information
Please describe any losses or claims filed on your Boat
Insurance in the last 3 years.Include the date and type of the loss, as well
as the amount of the claim


 
Additional Comments
Please use the box below to enter any additional information
you wish to include:
 

Agreement & Disclaimer

  • Thank you for requesting a quote from our agency. We are pleased to provide you with multiple ways to communicate your insurance needs to us, however please note:
  • Coverage via this online request is NOT bound until you have received a written acknowledgement from our office.
  • *Protecting your privacy and identity is very important to us.  Your Social Security number is required to complete a quote. You can send it to us securely by entering it on this form, however we will contact you personally if you prefer to omit this information online.
    • Please be aware that we may use your social security number to run a credit check.  We may also run an MVR (motor vehicle report) and a CLUE report of loss information. These reports are necessary for any and all insurance quotes we provide either online or in person. 
  • By clicking "Submit" you acknowledge that you understand and agree to this information.

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