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Start here for a great Recreational Vehicle Insurance experience!
How did you hear about us?
*
Please Select
I am a current client
Google
Facebook
Other Social Media
A Customer Referred Me
Saw Your Sign
Met An Agent At An Event
My Mortgage Lender Referred Me
My Realtor Referred Me
Other
Which agent are you working with?
*
Please Select
Adrienne Boyd
AmyBeth Full
Andy White
Brad Davis
Christina van Eeden
Unknown
Which recreational vehicle(s) would you like to insure?
*
Boat/Personal Watercraft
Motor Home/Travel Trailer
Motorcycle (road use)
Golf Cart/LSV/ATV
Name
*
First Name
Last Name
My preferred name (nickname) is:
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Do we have permission to communicate via text with you at this number?
*
Yes (recommended)
No
Date of Birth
*
/
Month
/
Day
Year
Date
Social Security Number
Optional - (but use dashes)
Full Drivers License Number & State
*
Don't forge the state!
Age when you got license
*
Occupation (if retired include previous occupation)?
*
What is your highest level of education?
*
Please Select
Less than High School
High School or GED
Some College
Associate's Degree
Bachelor's Degree
Master's Degree
P.H.D.
J.D. (Attorney)
M.D. (Medical Doctor)
Have you completed a Boating Safety Course?
*
Name and date completed
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you own or rent your home?
*
Please Select
I own - i's a house
I own - it's a condo unit
I own - it's a mobile home
I rent
I live with my parents/family
Other
How long have you lived at your residence?
*
Specify months or years
Marital Status
*
Please Select
Married
Single
Divorced
Widowed
Significant Other
Other
Spouse's Name
*
First Name
Last Name
Spouse's preferred name (nickname) is:
Spouse's Date of Birth
*
/
Month
/
Day
Year
Date
Spouse's DL Number, State & Age Licensed
*
Don't forget the state!
Has spouse completed a Boating Safety Course?
*
Name and date completed
Boat section
Boat Information
Are there any additional owners not listed above?
*
If yes, provide name, date of birth, DL#, and address for them in notes below.
Are there any additional drivers not listed above?
*
If yes, provide name, date of birth, DL#, and address for them in notes below.
Is any owner a member of an Affinity Group?
*
Please Select
No
AARP
Del Mar
USAA
Other - please put in notes
This may provide a discount!
Storage or Mooring Location
Name of marina or address stored
Is this a new purchase or currently insured?
*
Please Select
New purchase
Currently insured
Neither
Name of current insurance company
Date purchased
/
Month
/
Day
Year
Date
Requested date for coverage to begin
*
/
Month
/
Day
Year
Date
How many years have you owned your boat?
*
Is it owned or financed?
*
Please Select
Lien/Loan - I make mayments
Leased
Own - no payments
Name and address of leinholder/leaseholder?
Type 'will provide later' if you do not have this info available.
Years of experience driving boats (for main driver)?
*
Use of boat
*
Please Select
Residence
Fishing
Skiing
Racing
Stunt
Business
Pleasure
Rented
Other
Coastal or inland water use?
*
Please Select
Inland (fresh water) only
Fresh & coastal water - less than 50 miles from shore
Fresh & coastal water - possibly over 50 miles
Type of boat/watercraft?
*
Please Select
Center Console
Deck Boat
Pontoon or Tritoon
Catamaran
Personal Watercraft (Sea-Doo, WaveRunners, etc.)
Cabin Cruiser
Sailboat
Houseboat
Jon Boat
Bass Boat
Bay Boat
Other - specify in notes at bottom
HIN
Hull ID #
HULL - Year, Make, & Model
Length
Hull material
Value of Hull
Motor Style
*
Inboard
Outboard
Inboard/Outboard (Sterndrive)
Jet-Drive
Other
Fuel type
*
Please Select
Gas
Diesel
Other
How many engines?
*
Please Select
1
2
3
4 or more
(do not include trolling motors here)
Info for each engine (not trolling motors)
Total Horsepower
*
Do not include an trolling motors
Max speed
*
Trailer Information
VIN, year, make, model, and value
Trolling or other motors?
Type, value, and horse power for each
Estimated value of attached equipment
What is attached and value.
Estimated value of fishing or other gear
Value and briefly describe
Has any owner or driver had an auto or marine violation or claim in 5 years?
Please Select
Yes
No
Not sure
Come on, be honest.
Accident or Violation details:
Name, type, date, and amount paid
What coverage(s) do you want?
*
Yes
No
Not Sure
Liability
Comprehensive
Collision
Towing/On water service
Roadside Assistance
Hurricane Haul Out
Physical Damage Coverage on Trailer
Environmental Coverage (if available)
Other
Motor Home/Travel Trailer section
Motor Home/Travel Trailer Information
Vin#
Year
Make
Model
Value
Length
Weight
Where is this vehicle primarily located?
*
Campground, home, fenced lot, address, etc.
Do you live in this vehicle full time?
*
Years of experience driving this type of vehicle?
*
Are you a member of of an RV association?
*
Provide name of association
Motorcycle section
Motorcycle (road use)
Where is your vehicle kept?
*
Your garage, driveway, fenced lot (give address), etc.
VIN
Year
Make
Model
Value
Primary Vehicle Use?
*
Please Select
Pleasure
Commute (to/from work or school)
Other
Annual Miles Ridden?
*
Please Select
0 - 1000
1001 - 2500
2501 - 5000
5001 - 7500
7501 - 10,000
10,000+
How often do you ride in season?
*
Please Select
5-7 Days per week
3-4 Days per week
1-2 Days per week
1-3 Days per month
Electric or gas?
*
Electric
Gas
How many CCs?
Is your vehicle custom built?
*
Please Select
Yes
No
Has it been converted to a trike?
*
Additional equipment exceeding $3,000
*
Yes or No, if yes give value
Has it been supercharged?
*
Yes or No
Do you have a motorcycle license or endorsement on your drivers license?
*
Please Select
Yes
No
How many years of experience do you have driving a motorcycle?
*
Have you completed an approved safety course in 3 years?
*
Please Select
Yes
No
If yes, proof will be required for discount.
Are you a member of a motorcycle association?
*
Please Select
No
Yes - Harley Owners Group
Yes - USAA Member
Yes - Other
Are there any additional drivers not listed above?
*
If yes, provide name, date of birth, DL#, and address for them in notes below.
Golf Cart section
Golf Cart/LSV/ATV
What type of vehicle are you looking to insure?
*
Please Select
Golf Cart
Low Speed Vehicle (LSV)
ATV/Motorcycle (off road use)
Other
Where is your vehicle kept?
*
Your garage, driveway, fenced lot (give address), etc.
Vin or Serial #
Year
Make
Model
Value
Electric or gas?
*
Electric
Gas
How many CCs?
Is your vehicle custom built?
*
Please Select
Yes
No
Additional equipment exceeding $3,000
*
Yes or No, if yes give value
Has it been supercharged?
*
How many years of experience do you have driving this type vehicle?
*
Are there any additional drivers not listed above?
*
If yes, provide name, date of birth, DL#, and address for them in notes below.
Begin notes and submit
Any additional notes you would like us to know?
Please upload any current declarations pages if available.
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