Please provide the following information to obtain a quote.
Please remember, that no coverage should ever be considered bound until you have received confirmation from our office.
What is your name: *
How can we contact you: *
Phone Email
What type of phone number is this: *
Home Work Mobile
Please tell us about the boat you want quoted.
Make: *
Model: *
Serial number: *
Describe the ownership of the boat: *
Boat is leased Boat is financed Boat is owned with no leases or loans
Name and address of leasing institution: *
Name and address of lending institution: *
What is the hull type: *
Cruise/Power Houseboat Multi-hull/Power Multi-hull/Sail Personal Watercraft Pontoon Runabout Sail Trawler Other
What kind of fuel does it use: *
What type of motor does it have: *
Outboard Inboard Inboard/Outboard
What is the current value of the boat: *
What is the length: *
What is the horsepower: *
What is the maximum speed: *
Will this boat be used for business: *
Yes No
Will this boat be used for racing: *
Yes No
Will this boat be used for parasailing: *
Yes No
Will this boat be used for water skiing: *
Yes No
Is this boat home-built: *
Yes No
Does this boat have a fire extinguisher: *
Yes No
Where will the boat be moored or stored: *
Please provide information on the drivers who will be operating the boat
First and last name of driver: *
Driver's license number: *
State where driver's license was issued: *
Occupation: *
Do you need to add information about a second driver: *
Yes No
Please provide information on the second driver
First and last name of driver: *
Driver's license number: *
State where driver's license was issued: *
Occupation: *
Do you need to add information about a third driver: *
Yes No
Please provide information on the third driver
First and last name of driver: *
Driver's license number: *
Occupation: *
State where driver's license was issued: *
Do you need to add information on a fourth driver: *
Yes No
Please provide information on the fourth driver
First and last name of driver: *
Driver's license number: *
Occupation: *
State where driver's license was issued: *
Please provide information about your existing insurance
Is this boat/watercraft currently insured: *
Yes No
Coverage Information
What liability limit would you like quoted on this boat: *
$1,000,000 $500,000 $300,000 $100,000
What collision deductible would you like to apply: *
$1,000 $500 $250
What comprehensive deductible would you like to apply: *
$1,000 $500 $250
How did you hear about us?: *
I am a current customer A Friend Internet Search Engine Newspaper Other Employee
Additional Information
Comments or additional information:
Did You Know Jet skis, wave-runners, and other portable water toys are not automatically included on your policy.
Would you like someone to contact you about this: *
Yes No
