Boat Insurance Quote Request

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. (* At least one operator is required)
Name:
DOB:
Course Completed
YesNo
Name:
DOB:
Course Completed:
YesNo
Name:
DOB:
Course Completed
YesNo

Boat Information
Is the boat currently insured? (*)
YesNo

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

What is the boat used for? (*)
Where is the vessel stored? (*)
Waters navigated? (*)


Hull Information
Year (*)
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? (*) YesNo
Make
Value $


Liability Coverage
Liability Coverage (*)
Medical Payments (*)

Has any listed operator been involved in a boating accident within the past 5 years? (*)
YesNo

If yes, please provide details

Has your boat and/ or equipment suffered damage from any cause within the past 5 years? (*)
YesNo
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? (*)
YesNo
If yes, please provide details

Additional Comments