Boat Insurance Quote

Name (*)
Email (*)
Phone (*)
How should we contact you?


Operator Information
List names along with their date of birth and if each operator has completed Coast Guard Auxiliary or Power Squadron course

Boat Information
Is the boat currently insured?
 Yes No

If yes, when does the policy expire?
Type of boat

What is it used for?
Where is the vessel stored?
Waters navigated?


Hull Information
Year Built
Make and Model
Hull type
Length (feet)
Estimated Market Value ($)
Maximum speed (MPH)
Personal effects (value - $)


Engine Information
#1 Engine
Year & Make
Type
Fuel type
Estimated Value (Outboard only -$)
Horsepower
#2 Engine
Year & Make
Type
Fuel type
Estimated Value (Outboard only - $)
Horsepower


Trailer Information
Trailer?  Yes No
Make
Value $


Liability Coverage
Liability Coverage
Medical Payments
Waterski Medical
 Yes No

Has any listed operator been involved in a boating accident within the past 5 years?
 Yes No
If yes, please provide details
Has your boat and/ or equipment suffered damage from any cause within the past 5 years?
 Yes No
If yes, please provide details
Has any listed operator been involved in an auto accident or received a moving traffic citation within the past 3 years?
 Yes No
If yes, please provide details

Additional Comments