Return to homepage

Boat/Watercraft Insurance Quote

We would like to provide you with a free, no-obligation boat/watercraft insurance quote. Please provide as much information possible for most accurate quote. This information will be kept confidential and will be used for quote purposes only.

Personal Information
Name : 
Address : 
City :   State:  Zip: 
Day Phone :  Night Phone :
Best Time To Call :  [hh:mm]  AM  PM
Email Address : 
Current Boat/Watercraft Insurance Information
Company Name ( not agency ) : 
Policy Expiration Date :  [DD/MM/YYYY]
Premium Amount $
Term :  6 Months 1 Year Other
Coverages
( Input only for those desired )
Type Sums Insured Type Sums Insured
Hull-Physical Damage $ Tender / Dinghy $
Liability Coverage $ Crew Liability $
Owner / Operator M&C $ Medical Payments $
Commercial Passenger Liability $ Uninsured Boater $
Trailer $ Personal Property $
Non-Emergency Towing $ Other $
Vessel Information
Vessel Name :
 Manufacturer/Model :
Year
 Length
 Date
Purchased
(DD/MM/YYYY)
 Purchase
Price
$ 		Present
value
$ 		Max
Speed
mph 		Registration #
Hull Identification #:
 Waters to be Navigated:
Tenders or Dinghies:
 Storage Address (Street, City, Co., St.):



LAID UP (DD/MM/YYYY)
From: to On Shore Afloat
Stored on Trailer:
Y N

Will be trailered over 100 miles: Y N
Equipment
( please select ALL equipment on your Boat/Watercraft)
Bilge Pumps CO2/Hallon System Aux generator, Diesel
EPIRB Fume Detector Aux generator, Gas
Sonar Fire Extinguishers Other (list below)
Depth Sounder Cooking stove
LORAN / Direction Finder Engine Alarm
GPS Anti-theft Devices
Radar Life Raft
SATNAV / OMEGA Ship to Shore Radio
Miscellaneous Information
( please check ALL that apply )
Primary Power Type of Hull Hull Material Fuel Tank
Sail Sailboat Wood Metal
Outboard Performance Metal Fiberglass
Inboard Runabout Fiberglass
Inboard/Outdrive
Other
Engine/Outboard Motor Information
( please complete for each engine )
Eng H.P. Gas Deisel Year Date Purchase
(DD/MM/YYYY)		 Purchase
Price		 Present Value
1 $ $
2 $ $
3 $ $
  Manufacturer / Model Serial Number
1
2
3
Trailer Information
Year
 Date Purchased(DD/MM/YYYY)
 Purchase Price
$ 		Present Value
$
Manufacturer / Model
 Serial #
Operators
( always list insured as Operator #1 )
# Name DOB
(DD/MM/YYYY)		 Auto DL # State Social Security# USCG/Power Squadron Certificate
1
2 n/a
3 n/a
# Auto violations/suspensions in last 5 years Years of Boat Ownership
1
2
3
Boat/Watercraft Usage
# Explain all YES responses in REMARKS Yes/No # Explain all YES responses in REMARKS Yes/No
1 Is the boat chartered to others with captain? Y
N		 6 Is the boat used commercially or for business purposes? Y
N
2 Is the boat chartered to others without captain? Y
N		 7 Does the applicant employ a paid crew?
If yes, how many?		 Y
N
3 Is the boat used for racing? Y
N		 8 Was any operator involved in any marine loss in the last 10 years(insured or not)? Y
N
4 Is the boat used for water skiing or diving? Y
N		 9 Was any coverage declined, cancelled or non-renewed in the last 2 years? Y
N
5 If the boat is used for fare paying passenger charters, what is the average number of passengers per trip?
Number of Trips per year
REMARKS
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 operators, coverages, etc., please enter them here
Please click on the "Submit Quote" button to send your quote request
One of our representatives will respond to your submission as soon as possible