EmailMeForm
9.1 - BOAT Quote
In order to quote your watercraft Insurance, we will need the following information to accurately quote your coverage. We have several companies writing Boat Insurance, and we want to get you the absolute, rock bottom quote with every discount you qualify for. In order to do that, this information is necessary, as well as a COPY OF YOUR CURRENT BOAT DECLARATION (DEC) PAGE (if you have one). If you can supply this information, I will immediately go to work for you.
ALL INFORMATION PROVIDED HERE WILL BE SENT to us SSL - SECURE SOCKET LAYER - ENCRYPTED for your security
Name as on Title
*
Phone Number
*
###
-
###
-
####
Email
*
Who told you about us?
*
Full Adress (city, state, zip)
Type of facility (yacht club, marina, private residence?
*
Have you taken a boaters safety course? Which one?
List ALL operators names, dates of birth, DRIVERS LICENSE NUMBERS, marrital status and state issued:
*
Number of kids in house under 18
*
List last 3 years Motor Vehicle record
*
2. Social Security # of Primary operator:
Years boating experience in length class
*
7. Is the watercraft used for hire or any type of business?
*
Yes
No
..... If yes, please describe specifically:
Owned or Leased
*
Owned
Leased
Is there a lienholder?
Yes
No
..... If yes, which one(s)?
What company are you currently insured with?
How long have you been insured with your current carrier?
Any bankruptcies or foreclosures in the past 7 years
*
Who is your current Homeowners Insurance provider?
*
Do you carry Umbrella Liability?
*
Year, make and model of boat
*
Value of Boat & Motor
*
Trailer: Year, make and model And Value
Length
*
Horsepower and make
Propulsion Type
Outbourd
In/Out
Sail
Jet
Construction
Fiberglass
Metal
Wood
Inflatable
Mooring site
My Home on canal
Marina Dry
Marina Wet
Yacht club
Dry Storage other
Trailer in Garage
Trailer outside
Mooring address
*
Coverage Options
*
Liability 100k
Liability 300k
Liability 500k
Hull Ded 500
Hull ded 1000
Hull ded 2000
Medical
Trailer (physical damage cov)
Pick one Liability Limit and one Hull Deductible if you want Physical damage coverage
Comments
A copy of your current dec page (if no attachments, please leave blank)
Powered by
EMF
Online Order Form
Report Abuse