Boat Insurance Quote Sheet
Our Insurance Rates ARRRR Amazing!!!!
Basic Information
Tell us about yourself
Applicant Name
*
First Name
Middle Initial or Name on License
Last Name
E-mail
*
example@example.com
Phone Number
*
Address
*
Applicant DOB?
*
-
Month
-
Day
Year
Date
Is there a co-applicant?
*
Yes
No
Co-Applicant Name
*
First Name
Middle Initial or Name on License
Last Name
Co-Applicant DOB?
*
-
Month
-
Day
Year
Date
Have you lived at this address for at least 24 months?
*
Yes
No
Prior Address if this is a new purchase or if you have lived there under 24 months
*
Is your mailing address the same as your home address?
*
Yes
No
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Boat Information
Underwriting Questions
Effective Date
-
Month
-
Day
Year
Date
Is this vessel a boat or jet ski?
*
Boat
Jet Ski
Who is the manufacturer?
*
Example: Wellcraft, Luhrs, Sea Ray
Model
*
SLX 350 OB
Year?
*
Length in Feet
*
Hull type
*
Fiberglass
Aluminum
Steel
Roplene
Carbon Fiber
Wood
The Hull ID
*
The vessel's VIN
Propulsion Type
*
Outboard
Inboard/Outboard (Stern Drive)
Inboard
Jet
Sail Powered
If sail powered, does the vessel have an engine?
*
Yes
No
Number of Motors or Engines?
*
1
2
3
4
5
Engine 1
*
Year Make Model and Vin
Engine 2
*
Year Make Model and Vin
Engine 3
*
Year Make Model and Vin
Engine 4
*
Year Make Model and Vin
Engine 5
*
Year Make Model and Vin
Are there thrusters?
*
Yes
No
Type of thrusters?
*
Bow
Stern
Both
Fuel type Gas or Diesel?
*
Gas
Diesel
Total Horsepower or CC's?
*
Maximum Speed in MPH?
*
Do you have a recent marine survey or a bill of sale?
*
Yes
No
Do you want insurance for a trailer, other than for Liability?
*
Yes
No
What is the make model and vin number for the Trailer?
*
Make, Model and VIN Number
Market Value of the Trailer
*
Year you purchased your boat?
*
Is your vessel ever stored at a Marina or Yard or Moored?
*
Yes
No
Boat Storage out of season?
*
At my Home
At a Marina or Yard
Boat Storage in season?
*
At my home on a trailer
At my home on a dock
At a Marina
Docked
Moored
Mooring, Marina or Dockage Name?
*
The Mooring, Marina, Docking or Yard Address
*
Stored in or out of water when not in season?
*
Not in Water
In Water
Boat Coverage Options
Arrr there some discounts for you Matey?
Is this a liability only policy?
*
Yes
No
Bodily Injury Liability Coverage:
*
25,000/50,000
50,000/100,000
100,000/300,000
300,000/300,000
500,000/500,000
1,000,000/1,000,000
300,000 CSL
500,000 CSL
1,000,000 CSL
You hurt people coverage
Property Damage Liability Coverage:
*
25,000
50,000
100,000
300,000
500,000
1,000,000
You hurt people coverage
Collision Deductible:
*
None/Liability Only
$100
$250
$500
$1000
A percent of the Boats Value
.
Comprehensive Deductible:
*
None/Liability Only
$100
$250
$500
$1000
A percent of the Boat Value
Uninsured Boater Coverage:
*
25,000/50,000
50,000/100,000
100,000/300,000
300,000/300,000
500,000/500,000
1,000,000/1,000,000
300,000 CSL
500,000 CSL
1,000,000 CSL
For when the other guy hurts you and has no insurance.
Medical Payments:
*
None
$1,000
$2,500
$5,000
$10,000
Medical treatment coverage
Towing
*
Yes
No
If possible, would you like to insure hull to an agreed value?
*
Yes
No
Dollar amount of agreed value hull?
*
A dollar amount
How much in agreed value Engines?
*
A dollar amount
Replacement valve of your stuff on the boat.
*
Personal Effects, fishing poles, etc.
Include mechanical breakdown coverage for the engine? If eligible
*
Yes
No
Is there a lien holder?
*
Yes
No
Lien holder name?
*
Lien holder address
*
Street Address or PO Box
Street Address Line 2
City
State / Province
Postal / Zip Code
Boat Operator Information
Arrr there some discounts for you Matey?
Driver's License Identification Number
*
Have you taken an approved Boating Safety Course?
*
Yes
No
Year of Boating Experience
*
Captain's License, Affiliated Marine Organizations, Additional Driver info, Dealer Contact.
Does the operator or owner have any tickets, claims or accidents of any kind in the last 5 year?
Please list all incidents and approximate dates of occurrences, if any?
Do you have more than one boat or personal water craft?
Yes
No
Notes Center
Place all notes here.
Upload Center
Upload files such as Marine Surveys and current declarations pages
Submit
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