Watercraft Coverage
Please fill out the form and click on the submit button at the bottom of the page for a quote on watercraft coverage.
Contact Information
Name (first and last)
Street Address or PO Box
City
State Zip
Phone
Fax
Email
Best time to reach me
Mornings Afternoons Evenings
Best way to reach me
Phone Fax Email
Boat Information
Power
Inboard Outboard Inboard/Outdrive Waterjet Sail
Type of Hull
Cabin Cruiser Open Cockpit Sailboat Bass Personal Watercraft
Hull Material
Fiberglass Metal Wood
Year
Manufacturer and Model
Length
Maximum Speed
Present Value
Water Navigated
Inland Ocean Both
Engine/Outboard Motor 1
Coverage/Limits of Liability
Liability (or Protection & Indemnity)
Medical Payments
Uninsured Boaters Liability
Operators (List all residents and dependants (licensed or not) and regular operators
Name
Date of Birth (mo/day/year)
Auto Drivers License and State
1
2
3
4
5
General Information
Yes
No
Is the boat chartered to others?
Is the boat used for commercial or business purposes?
Is the boat used for racing?
Is the boat used for waterskiing?
Does the applicant employ a crew?
Has any operator had an accident/conviction during the last three years?
Have any losses occured during the last three years?
Please explain all yes answers below
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