Client Information Your Name (required) Your Phone Number (required) Your Email Address (required) Your Mailing Address (required) Date of Birth (required) Driver's License State and Number (required) Insured's Occupation Marital Status (required) ---SingleMarriedWidowed Tickets or Accidents in the past 3 years (required) How many years of experience driving boats? (required) Boat Information Type (i.e. pleasure, fishing, sail, etc.) How many months per year is the boat used? Year, Make, Model (required) Boat Length in Feet (required) Hull Material ---FiberglassSteelAluminumWood HIN# (Hull Identification Number) Maximum Speed Number of Engines (Make & Serial/Registration #) Total Horsepower (excluding Trollin & Kicker Motors) Propulsion Type ---InboardOutboardInboard/OutboardJetSail Actual Cash Value (cost minus depreciation) Rating Base (include value of trailer & boating equipment if coverage desired): Date of Purchase or Current Coverage Information (name/company) Do You Need Trailer Coverage? ---YesNo Underwriting Information Primary Residence ---Own home/condoOwn mobile homeRentLive with ParentsOther Docking/Mooring/Storage Full Address All waters to be navigated Navigation in International Waters or Bahamas? ---YesNo Fire Prevention/Extinguishing Equipment Have You Taken A Safety Course? ---YesNo Limits of Coverage and Special Requests
Your Name (required)
Your Phone Number (required)
Your Email Address (required)
Your Mailing Address (required)
Date of Birth (required)
Driver's License State and Number (required)
Insured's Occupation
Marital Status (required) ---SingleMarriedWidowed
Tickets or Accidents in the past 3 years (required)
How many years of experience driving boats? (required)
Type (i.e. pleasure, fishing, sail, etc.)
How many months per year is the boat used?
Year, Make, Model (required)
Boat Length in Feet (required)
Hull Material ---FiberglassSteelAluminumWood
HIN# (Hull Identification Number)
Maximum Speed
Number of Engines (Make & Serial/Registration #)
Total Horsepower (excluding Trollin & Kicker Motors)
Propulsion Type ---InboardOutboardInboard/OutboardJetSail
Actual Cash Value (cost minus depreciation)
Rating Base (include value of trailer & boating equipment if coverage desired):
Date of Purchase or Current Coverage Information (name/company)
Do You Need Trailer Coverage? ---YesNo
Primary Residence ---Own home/condoOwn mobile homeRentLive with ParentsOther
Docking/Mooring/Storage Full Address
All waters to be navigated
Navigation in International Waters or Bahamas? ---YesNo
Fire Prevention/Extinguishing Equipment
Have You Taken A Safety Course? ---YesNo
Limits of Coverage and Special Requests
