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Date of Birth
State / Province / Region
Postal / Zip Code
Best Day and Time to Call
Boat Year (Must be a 2017 or newer to qualify)
Boat Purchase Date
Motor Make/Model and HP
Primary operator Drivers License Number
Boat insurance provider
How Soon Do You Need Coverage
Years experience operating a watercraft?
Have there been any boating losses in the last 3 years?
Any automobile / watercraft violations occurring in the past 3 years?
Has this driver's license been suspended or revoked in the last 3 years?
Does any operator have any criminal convictions(Arson/Burglary/DUI) within the past 5 years?
Has this client's insurance ever been canceled, declined, or non-renewed?
Will you be guiding from this watercraft
Other quotes to be included
Firearm Liability Insurance
Agent Preference if Available
Questions or Comments