Kansas Preferred Insurance Group Boat Quote Sheet

Kansas Preferred Insurance Group Boat Quote Sheet

913-585-1981 34102 Commerce Dr Ste B De Soto, KS 66018 www.kpigroup.net
Client Name:*

First NameLast Name
Date of Birth*
Driver's License Number*
Spouse Name:

First NameLast Name
Date of Birth
Driver's License Number
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Boat Storage Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number:
Email Address:
Boat Information
Effective Date:

MonthDayYear
Date
Current Insurance Company:
Policy Term Length:
Billing Schedule:
Boat Coverages
Bodily Injury Limit:*
Property Damage:*
Underinsured/Uninsured Boater:*
Optional Coverages

On-Water TowingRoadside Assistance/Trip InterruptionPersonal Effects
Collision Deductible:*
Comprehensive Deductible:*
Boat 1: Year Built*
Boat 1: Boat Length
Boat 1: Manufacturer
Boat 1: Model
Boat 1: Hull ID
Boat 1: Number of Motors
Boat 2: Year Built*
Boat 2: Boat Length
Boat 2: Manufacturer
Boat 2: Model
Boat 2: Hull ID
Boat 2: Number of Motors
Boat 3: Year Built*
Boat 3: Boat Length
Boat 3: Manufacturer
Boat 3: Model
Boat 3: Hull ID
Boat 3: Number of Motors
Describe any losses or claims in the past 5 years.
Should be Empty:

Boat Information