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Sailboat 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.

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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
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
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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