Naples Premier Insurance Group Boat Insurance Information
Please provide information on your boat so we can start working on saving you money!
Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
DATE of Birth
*
-
Month
-
Day
Year
Date
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Boat Information
Year:
Make:
Model:
Length:
Hull ID #:
Purchase Price:
Purchase Date:
Address of where boat is kept:
How is the boat stored?
Dry storage
On a lift
Trailer inside
Trailer outside
Motors
Number of engines:
Total HP:
Year of motors:
Make of motors:
Serial #'s of each motor:
Trailer
Trailer Manufacturer:
Year:
Serial #:
Value:
Marina Name:
Mooring Address:
Mooring Type:
Any prior losses?
Yes
No
Please provide any information if yes:
Who is your prior insurance provider?
Lienholder:
Driver Information
Driver License #:
Driver License State:
Driver Information
Driver #2
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Driver License #:
Driver License State:
Relationship to named insured:
Driver Information
Any Additional Drivers
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Driver License #:
Driver License State:
Relationship to named insured:
Please upload a picture of the driver’s licenses for all included drivers and a copy of your current insurance declarations page:
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