Obligation-Free Boat Quote

Name
Address
City		State	Zip
Home phone		Work Phone
E-mail (required)
Social Security
Many of the companies that we represent require social security number prior to quoting.
Present Ins Co
Renewal Date

Boat Information
Year		Manufacturer		Model
Length		Horsepower		Speed
Navigation area (include state)
Inland			Coastal
Safety Equipment:
GSP     Automatic CO2     Burglar Alarm     Radar

Outboard Motor Information
Year		Manufacturer	Twin: Yes No
Total horsepower:

Boat/Yacht Value:
Outboard Motor Value:
Boat/Motor Deductible:	1% 2% 3% 5% 10%
Tailer Value:	Subject to $100 deductible
Fishing Equipment:	Subject to $250 deductible

Coverage Limits
Liability Includes Uninsured Boater	$100,000	$300,000	$500,000
Commercial Towing	$400	$600	$800	$1,000
Personal Property	$500	other
Medical Payments	$1,000

General Information
Any youthful principal operators?	Yes No
If yes, enter date of birth
Three years boating experience?	Yes No
If no, enter number of years
Prior boating losses?	Yes No
Please, provide loss date and details.
Accidents/Convictions in last 5 years?	Yes No
Please, provide date and details.
Multi-Ownership? (Other than spouse)	Yes No
If yes, please provide more information.

Please return my quote via

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Web page created by
Iwona Gorzkowicz