Boat / Marine Quote Form
Please provide us with the required information so we can provide you a FREE no-obligation quote
First Name
Last Name
Current Address
Email
Phone Number
Social Security Number: Not required for WA State residents, however we will be able to provide a more accurate quote
Who is your current insurance carrier?
What is the expiration date of your current boat policy?
Years of Boating Experience?
Has the driver taken any safety courses?
Yes
No
Safety Course Taken?
Select an option
None
USCG Course
USCG Auxiliary
USPS
Captain
Boat Info (Year, Make & Model)
Serial / Hull #
Registration #
Type of Hull
Select an option
Cabin Cruiser
Open Cockpit
Sailboat
Pontoon
BASS
Personal Water Craft
SKI
Other
Length
Maximum Speed
Boat Use
Select an option
Pleasure
Residence
Commercial
Racing
Fishing
Is trailer included in value of boat?
Yes
No
Trailer- Year, Make, Model, VIN and Cost?
250
Motor Information: Year, Make Model & Horsepower
250
Inboard / Outboard / I/O
Select an option
None
Inboard
Outboard
I/O
Gas / Diesel
Select an option
Gas
Diesel
N/A
Serial #
Driver Name
Date of Birth
Marital Status
Select an option
Single
Married
Divorced
Widowed
Residence Type
Rent
Own
Live with Parents
Education
Select an option
GED
High School
AA
Bachelors
Masters
Doctor
PhD
JD
Drivers License Number and State Licensed
List Boat Violations
250
List/Describe Any Accidents
250
Add a 2nd driver?
Yes
No
Second Driver Info. Name, DOB, and Driver License Number
Liability Coverage & Limits
$25,000/$50,000/$25,000
$50,000/$100,000/$50,000
$100,000/$300,000/$100,000
$250,000/$500,000/$100,000
Deductible Boat
$50.00
$100.00
$200.00
$500.00
$1,000
Towing Coverage
Yes
No
Comments or Questions
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