Our carriers offer 10% off your Home and Auto Insurance when we write both policies.
"Remember, All Our Policies Come with an Agent!"
We Are Proud Members of the Better Business Bureau!
OPERATOR INFORMATION #1
Name:
Birthdate:
Sex (M/F):
# Years U.S. Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:
Number & Type of Accidents last 3 years:
Number & Type of MINOR Cites last 3 years:
Number & Type of MAJOR Cites last 3 years:
Number of Years Boating Experience:
OPERATOR INFORMATION #2 (if none, leave blank)
Name:
Birthdate:
Sex:
# Years U.S. Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations in fields below:
Number & Type of Accidents last 3 years:
Number & Type of MINOR Cites last 3 years:
Number & Type of MAJOR Cites last 3 years:
Number of Years Boating Experience:
VESSEL & UNDERWRITING INFORMATION
Year of Boat:
Make & Model (be specific):
Boat Length:
Hull Type (wood, Metal, fiberglass, etc):
Max. Speed (in MPH):
Market Value: $
Engine Make:
Engine Type:
(Inboard, I/O, Jet)
Engine Horse Power:
Fuel Type:
(Gas, Diesel, etc.)
Trailer Cov. Needed?
Yes
No
Yr./Make/Model of Trailer:
Trailer Value: $
Where is boat
moored or stored?
Describe waters boat taken on?
Describe boat
general usage? (fishing, ski, etc.)
VESSEL COVERAGES:
Limits of Liability:
$15/30 BI / 10 PD
$25/50 BI / 15 PD
$50/100 BI / 25 PD
$100/300 BI / 50 PD
Hull Coverage:
NO Coverage
$250 Deductible
$500 Deductible
$1000 Deductible
Water Ski Medical Coverage?
Yes
No
Uninsured Motorists Cov.?
Yes
No
Comments or Remarks:
(List additional drivers, special coverages, etc. here)
Send my quotation via:
E-Mail Fax Regular Mail
Call me by Phone!
Thank you for filling out this form
COMPLETELY!
We value your input as PRIVATE information. Every step has been
taken to insure your privacy, security, and our intent is to release quote information only
to you. We will not give your data to ANY other person or group for sales, marketing,
or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to
release us from any liability should this information be accidentally viewed by others.
Our intention is to maintain your complete privacy.
Yes, I Agree.
Please Send Me a Boat Quote NOW!
Click Button Below When Done
Please Click Only Once . . . May take up to 30 seconds!
