Watercraft Quote
Fields marked (*) are mandatory.
Applicant Information
First Name*
Last Name*
Email Address*
Street Address*
City*
State*
Zip Code*
Home Phone #*
Work Phone #*
Current Insurance Company Name
Expiration Date of Current Policy
Current Premium
Applicants Date of Birth*
Drivers License Number*
Marital Status*
Social Security Number (Optional)
# of Major Violations (boat or auto)*
# of minor violations (boat or auto) *
# of Claims/Losses (5 years)*
# of Years Boating experience*
Any youthful principal operators? If yes, birth dates*
Describe where boat is used (summer/winter)
List Any Boating Safety Courses Taken or Licenses Held
Watercraft/Boat #1 info
Year*
Make*
Model*
Boat Type*
Length of boat*
Hull material*
Speed*
Safety equipment: GPS, burglar alarm, radar, automatic CO2*
Boat value*
Engine Year*
Engine manufacturer*
Engine Model*
Engine Size (horsepower)*
Engine Type*
Fuel Type*
Outboard motor value
If boat has custom equipment or accessories please explain
Trailer value
Value of fishing equipment or other personal property kept on boat
Total Value of Watercraft/Boat
Estimated Annual hours of usage*
Operator # 2 Info (If applicable)
Full Name
Date of Birth
Drivers license Number
Relationship to Applicant
Marital Status
Social Security # (optional)
# of Major Violations
# of Accidents,claims or losses
# of Years boating experience
Watercraft/Boat # 2 Info (If applicable)
Year
Make
Model
Engine Make and Size (horsepower)
If Boat has custom equipment or accessories please explain
Total value of boat/watercraft
Estimated annual hours of useage
Additional Info
Multi-ownership (other than spouse)?*
Best Time to Contact You*
Additional Comments or Questions
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