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Quote Request Form - Boat Insurance

* required

Personal Information
* Name:
* Address:
* City:  
* State:  
  * Zip:
Day Phone:
Night Phone:
Best Time To Call:   AM   PM
* Email:
Have you taken any
state boating courses? 		Yes
No
Driver 1
First Name
Last Name
Gender Male Female
Birth Date
Marital Status
Years Boating Experience
State Licensed
Occupation
Driver 2
First Name
Last Name
Gender Male Female
Birth Date
Marital Status
Years Boating Experience
State Licensed
Occupation
Driver 3
First Name
Last Name
Gender Male Female
Birth Date
Marital Status
Years Boating Experience
State Licensed
Occupation
Driver 4
First Name
Last Name
Gender Male Female
Birth Date
Marital Status
Years Boating Experience
State Licensed
Occupation
 

Boat Information

Boat 1
Year
Make
Model
Boat Length
Type
Identification
Serial Number
Cost New Value
Years of Boat Ownership
What Boating Course was Taken?
Watercraft Weight
Boat Hull Material
Where is it stored/moored?
What is the top speed?
Navigation Area
Ownership
Lienholder
Boat 2
Year
Make
Model
Boat Length
Type
Identification
Serial Number
Cost New Value
Years of Boat Ownership
What Boating Course was Taken?
Watercraft Weight
Boat Hull Material
Where is it stored/moored?
What is the top speed?
Navigation Area
Ownership
Lienholder
Boat 3
Year
Make
Model
Boat Length
Type
Identification
Serial Number
Cost New Value
Years of Boat Ownership
What Boating Course was Taken?
Watercraft Weight
Boat Hull Material
Where is it stored/moored?
What is the top speed?
Navigation Area
Ownership
Lienholder
 

Previously Owned Boats
Year
Make
Model
Boat Length
Type
Years of Boat Ownership
Describe Any Boat Losses
 

Motor Information

Motor 1
Year
Make
Model
Type
Identification Serial Number
Cost New Value
Horsepower or Motor Size
Ownership
Motor 2
Motor Information - Boat 2
Year
Make
Model
Type
Identification Serial Number
Cost New Value
Horsepower or Motor Size
Ownership
Motor 3
Year
Make
Model
Type
Identification Serial Number
Cost New Value
Horsepower or Motor Size
Ownership
 

Trailer Information

Year
Make
Model
Type
Identification Serial Number
Cost New Value
 

Deductible Information

  Boat & Motor Trailer
Comprehensive (Theft)
Collision
 

Violation Information
Last 3 years (minor violations)
Last 5 years (major violations)
Driver 1 Driver 2 Driver 3 Driver 4
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
  Bodily Injury Property Damage
Personal liability
Uninsured boat
Medical payment  
 

Deductible Information
Boat 1 Comprehensive (Theft)
Collision
Boat 2 Comprehensive (Theft)
Collision
Boat 3 Comprehensive (Theft)
Collision
Boat 4 Comprehensive (Theft)
Collision
 

Miscellaneous Information

Does the Boat have a Fire System?
Any Commercial Usage?
What is the Fuel Type?
List Electronic Aids in the Boat.
What is the Current Insurance Company?
What is the Policy Expiration Date?
What is the Current Premium?
 

Questions or Comments.




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