Boat/Watercraft Quote Request

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Effective Date:	*
Your Name:	*
Your Mailing Address:	Street * City * State AL AK AS AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip *
E-mail Address:	*
Daytime Phone:	*
Choose One:	Please call me with quote premium. Please send quote via e-mail.
Description of Property: Motor Type: Outboard Inboard Outdrive Waterjet Number of Engines: Twin Single None Boat Type: Sail Power Other Other Boat Type: Fuel: Gas Diesel None Maximum Speed: * Hull Material: Fiberglass Steel Wood Aluminum Other Other Hull Material:
Insured Watercraft: Boat: Year: * Manufacturer: * Model: * Serial Number: * Length: * Total HP: * Outboard Motor: Year: * Manufacturer: * Model: * Serial Number: * Total HP: * Trailer: Year: * Manufacturer: * Serial Number: *
Coverage's: Limits Boat (Including Auxiliary Equipment please break down o/b information) * Outboard Motor 1. (ACV Coverage) * Outboard Motor 2. (ACV Coverage) * Boat Trailer * Personal Property ($500 Automatic) * Commercial Towing ($400 Automatic) * Boat Liability (ACV Coverage) $300,000 $500,000 $100,000,000 Medical Payments ($100 Automatic with Liability) Automatic Only $Limit 1 $Limit 2 $Limit 3 Uninsured Boater Optional Coverage's Agreed Value Endorsement Actual Cash Value Fishing Equipment Limit:
Safety Equipment: Check all that apply: GPSAutomatic CO2 (Halon) Ship to Shore Radio (VHF)Depth Sounder Electronic Burglar AlarmRadar PlotterEPIRB Vapor Detector Alarm
Operator Information:
Date of Birth: * Years of Boating Experience: * Social Security Number: *
Waters to be Navigated:
Inland waters of the following states: Coastal waters of the following states:
Is the boat chartered or used for other than private pleasure purposes? NoYes
Previous Loss Information Please describe any losses or claims filed on your Boat Insurance in the last 3 years:
Date of loss:   Type of loss:   Amount of claim: *
Additional Comments Please use the box below to enter any additional information you wish to include.
We cannot bind coverage from an email or voicemail request. Coverage is bound after you complete an application and receive a written receipt from an agency staff member. If you have not received a response from us within one business day, please contact us again. Thank you.