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Boat/Watercraft Insurance Quote - Secure Online Form
We would like to provide you with a free no-obligation boat/watercraft insurance quote. Please provide as much information as possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.
 
Fields marked with a *are required.
 
 PERSONAL INFORMATION
Name of Main Insured 
Social Security # 
Address 
City 
State 
Zip 
Day Phone 
Night Phone 
Best Time to Call  am    pm
Email Address 

 CURRENT INSURANCE INFORMATION
Company Name 
(not agency) 
Policy Expiration Date 
Premium Amount   $ 
Policy Term  6 Months  1 Year  Other

 VESSEL COVERAGES  (enter amount of coverage only for those items desired)
Hull - Physical Damage   $
Liability Coverage   $
Owner / Operator M&C   $
Commercial Passenger Liability   $
Trailer   $
Non-Emergency Towing   $
Tender / Dinghy   $
Crew Liability   $
Medical Payments   $
Uninsured Boater   $
Personal Property   $
Other   $

 VESSEL INFORMATION
Vessel Name 
Manufacturer / Model 
Registration # 
Hull Identification # 
Tenders or Dinghies 
Waters to be Navigated 
Storage Address 
Storage City 
Storage County 
Storage State 
Year Length Max Speed
mph
Date Purchased Purchase Price Present Value
 $  $
Stored on Trailer Will be trailered over 100 miles
Yes   No Yes   No
Laid Up
On Shore   Afloat  From     To

 VESSEL EQUIPMENT
Select ALL equipment on your boat or watercraft
Bilge Pumps Fume Detector
EPIRB Fire Extinguishers
Sonar Cooking Stove
Depth Sounder Engine Alarm
LORAN/Direction Finder Anti-theft Devices
GPS Life Raft
Radar Ship to Shore Radio
SATNAV/OMEGA Aux Generator, Diesel
CO2/Halon System Aux Generator, Gas
List any additional equipment here

 MISCELLANEOUS (select all that apply)
Primary Power
Sail    Outboard    Inboard    Inboard/Outdrive    Other
Type of Hull
Sailboat    Performance    Runabout
Hull Material
Wood    Metal    Fiberglass
Fuel Tank
Metal    Fiberglass

 ENGINE/OUTBOARD MOTOR INFORMATION (complete for each engine)
ENGINE #1 INFORMATION
Manufacturer / Model 
Serial Number 
Type Year Horsepower
Gas    Diesel
Date Purchased Purchase Price Present Value
 $  $
ENGINE #2 INFORMATION
Manufacturer / Model 
Serial Number 
Type Year Horsepower
Gas    Diesel
Date Purchased Purchase Price Present Value
 $  $
ENGINE #3 INFORMATION
Manufacturer / Model 
Serial Number 
Type Year Horsepower
Gas    Diesel
Date Purchased Purchase Price Present Value
 $  $

 TRAILER INFORMATION
Manufacturer / Model 
Serial Number 
Year Date Purchased Purchase Price Present Value
 $  $

 VESSEL OPERATORS (list insured as Operator #1)
VESSEL OPERATOR #1 (insured)
Name 
Auto Drivers License # State Birth Date
USCG/Power Squadron Certificate Years of Boat Ownership
VESSEL OPERATOR #2
Name 
Auto Drivers License # State Birth Date
USCG/Power Squadron Certificate Years of Boat Ownership
VESSEL OPERATOR #3
Name 
Auto Drivers License # State Birth Date
USCG/Power Squadron Certificate Years of Boat Ownership

 BOAT/WATERCRAFT USAGE (answer all questions below)
1 Is the boat chartered to others with captain? Yes No
2 Is the boat chartered to others without captain? Yes No
3 Is the boat used for racing? Yes No
4 Is the boat used for water skiing or diving? Yes No
5 If used for payed passenger charters, number of passengers per trip?
If used for payed passenger charters, number of trips per year?
6 Is the boat used commercially for business purposes? Yes No
7 If applicant employs a paid crew, how many?
8 Was any operator involved in a marine loss in the last 10 years (insured or not)? Yes No
9 Was any coverage declined, cancelled or non-renewed during the last 5 years? Yes No
Explain all YES responses to these questions below

 ADDITIONAL COMMENTS
Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough fields above, such as additional drivers, vehicles, driver histories, etc..., please enter them here.
Please click on the "Submit Form" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.
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