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Boat Insurance

Boat Insurance Quote Form

If you would like to receive more information, please complete the information below.

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Information

Please be sure to complete all of the requested information so that your agent may contact you after receiving this notification.

*Named Insured   *Email  
Address Phone
City Cell Phone
State Best time to contact you
Zip Method of contact

Current Policy Information

Insurance Company Policy number Policy Expiration Date  
 

Coverage's

Type Amounts (input desired coverage's)
Hull Value $
Liability Coverage $
Trailer Value $
Personal Property $
Medical Payments $
Towing $

Vessel Information

Manufacturer/Model  
Year  
Length  
Date Purchased  
Purchase Price  
Max Speed  
     
  Engine 1 Engine 2
H.P.
Gas/Diesel
Inboard/Outboard I/O
Manufacturer:
     
Location of Vessel  
Waters navigated  

Miscellaneous

Primary Power Type of Hull Hull Material Fuel Tank









Trailer Information

Year    
Date Purchased    
Purchase Price    
Present Value    
Manufacturer/Model    

Operators

  Name DOB Auto DL # State
1.
2.
3.
         
  Auto Violations/Suspensions in last 5 years: Boating Experience (years)    
1.    
2.    
3.    

Boat/Watercraft Usage

Explain all YES responses in EXPLANATIONS Section below.  
1. Is the boat a charter boat?
2. Is the boat used commercially?
3. Is the boat used for racing?
4. Will you be water skiing or diving with your boat?
5. If the boat is used for charters, what is the average number of passengers and trips? per trip?     # of trips a year?  
6. If boat is used commercially, is there crew? If so how many?  how many crew  
7. Was any operator involved in a marine loss in the last 10 years (insured or not)?
8. Was any coverage declined, cancelled or non-renewed during the last 5 years?
EXPLANATIONS

Additional Information Section

In the box below, please provide any additional information you feel may be necessary for us to provide you with the best quote possible such as additional operators, coverage's extenuating circumstances, etc.







Please note that this form is for a REQUEST ONLY. By submitting this form it does not bind coverage in any way.  If you do not hear from us in a reasonable amount of time, ASSUME WE DID NOT GET THIS REQUEST FOR AN INSURANCE QUOTE, and call our office. I understand that filling out and submitting this form DOES NOT bind coverage in any way, and the only way coverage can be bound will be when I am informed of a binder or policy is issued by the agent representing me.