Boat Quote Landing Page

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 (required)

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? (required)

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) (required)

Do You Need Trailer Coverage? (required)
---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 (required)

Have You Taken A Safety Course?
---YesNo

Limits of Coverage and Special Requests (required)

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