BOAT/WATERCRAFT

1
Are you a new or existing customer?
New
Existing Customer Same Address
Existing Customer New Address
2
Name of Primary Insured
First Name
Last Name
3
Primary Insured EmailWe will email quote or confirmation once processed to this address
example@example.com
4
Phone NumberIn case we have any questions
Please enter a valid phone number.
5
Primary Residence Address
6
Are there any co owners?
YESNO
7
Co Owner Info
First & Last Name
8
How many regular operators should be listed on policy?
1
2
3
4
5+
9
Primary InsuredOperator 1
First and Last Name
Birthday
Drivers License Number
Experience operating a watercraft in years?
10
Additional operatorOperator 2
First and Last Name
Birthday
Drivers License Number
11
Additional operatorOperator 3
First and Last Name
Birthday
Drivers License Number
12
Additional operatorOperator 4
First and Last Name
Birthday
Drivers License Number
13
Additional operatorOperator 5
First and Last Name
Birthday
Drivers License Number
14
How many boats or watercraft are we including on quote or adding to existing policy?
1
2
3
4+
15
Boat 1
Year , Make, Model
Length in Feet
Propulsion Type (inboard or outboard motor?
Horsepower & Top Speed?
Construction Material (fiberglass, metal, wood, other)
HULL ID #
$$ Value of Hull
$$ Value of Motor(s)?
16
Boat 2
Year , Make, Model
Length in Feet
Propulsion Type (inboard or outboard motor?
Horsepower & Top Speed?
Construction Material (fiberglass, metal, wood, other)
HULL ID #
$$ Value of Hull
$$ Value of Motor(s)?
17
Boat 3
Year , Make, Model
Length in Feet
Propulsion Type (inboard or outboard motor?
Horsepower & Top Speed?
Construction Material (fiberglass, metal, wood, other)
HULL ID #
$$ Value of Hull
$$ Value of Motor(s)?
18
Boat 4
Year , Make, Model
Length in Feet
Propulsion Type (inboard or outboard motor?
Horsepower & Top Speed?
Construction Material (fiberglass, metal, wood, other)
HULL ID #
$$ Value of Hull
$$ Value of Motor(s)?
19
Will any boat be used in Ocean Waters?
YESNO
20
Which Boat(s) will be used in Ocean Waters?
21
Do you want to insure a boat trailer(s)?
YESNO
22
How many boat trailers do you have?
1
2
3
4
23
Trailer 1 info
Year, make, model
$$ Value
Trailer VIN or ID Number?
24
Trailer 2 info
Year, make, model
$$ Value
Trailer VIN or ID Number?
25
Trailer 3 info
Year, make, model
$$ Value
Trailer VIN or ID Number?
26
Trailer 4 info
Year, make, model
$$ Value
Trailer VIN or ID Number?
27
Where are boats stored during summer months?
Huge
Large
Normal
Small
Ok
Ok
28
Where are boats stored during off season?
Huge
Large
Normal
Small
Ok
Ok
29
Do you have any questions or is there anything we need to know?
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: