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Powerboat Quote

Let us quote your boat insurance! You may give us a call or complete the following form to receive a competitive quote. Only complete the fields that pertain to your situation.

North Carolina Residents Only!



Contact Information...
Name (required)
Address
Address (second line)
City
State
Zip

Please Contact Me Via...
Phone E-Mail Fax
Work Phone
Best Time To Call
Home Phone
Best Time To Call
Fax
E-Mail (required)

Current Insurance Information...
Current Insurance Company
(not agency)
Date Current Policy Expires
mm/dd/yyyy

Your Vessels...
  
Vessel 1
Vessel 2
Year
Length
Manufacturer
Model
Max Speed mph mph
Type of Craft

Other

Other
Hull Materials
Name of Craft
General Information
Purchase Price
$ $
Date of Purchase
mm / dd / yyyy mm / dd / yyyy
Storage / Mooring Location
Standard Area of Usage (Where is the Vessel Primarily Operated?)
Anticipated Trips Outside Standard Usage Area
Live on Board Yes No Yes No
Lay-Up Period Beginning Month
Ending Month
Beginning Month
Ending Month
Commercial Use Yes No Yes No
Used for Towing Sports
(skiing etc.)
Yes No Yes No
Paid Crew Yes No Yes No
Equipment / Maintenance
Date of Last Survey mm / dd / yyyy mm / dd / yyyy
Drive
Engine(s)
Engine Make
Engine Year
C.I. / H.P. (per engine)
Fuel
Fixed Fire System Yes No Yes No
Fume Sniffer Yes No Yes No
Requested Coverage Limits
Hull Value
Motor(s) Value
Trailer Value
Tender / Dinghy Value
Accessory Value
Physical Damage Deductible
Liability Limit
(applies to all vessels on policy)
Owner Information
Prior Boats Owned
Occupation of Owners
If Multi-Party Ownership, list names of other Owners including Companies.

Coverage Information
Current Insurer
Expiration Date of Current Policy
mm / dd / yyyy
Requested Effective Date
mm / dd / yyyy

Operators
Operator Name
1
2
3
4

Operator Number of Years
Licensed
Years of
Boating Experience
Courses
1

If Other
2

If Other

Driving Violations (not boating violations)
Incident Driver Involved Ticket / Violation Violation Date
(MM/DD/YYYY)
1
2
3
4

This is a Request For Quotation Only.
No coverage is in effect until bound by an insurance carrier.


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