Watercraft

Please fill out the form below to get us started on your Quote.  We'll get it going and give you a call within an hour, during normal business hours, to ask a couple of additional questions.  Our follow-up call should take less than 5 minutes and you'll have a price that could save you hundreds of dollars over the year.

Telephone Number:*

Email Address:

First Name:*

Middle Name:

Last Name:*

Male  Female

Date of Birth:*

Marital Status:

Driver's License Number:*

Driver's License Status:

Years Boating Experience:

Name, Date of Birth, and Marital Status of Other Operators:

Driving Record (prior 35 months) for all drivers:

AF/NAF Auto and Boat/PWC Accidents::

Boat Information 

Type (i.e., pleasure, fishing, sail, etc.):*

Year:

Year Purchased:

Make:*

Model:*

Length:*

HIN #:

Number of Engines:*

Total Hoursepower (excluding trolling and kicker motors):

 Propulsion Type:

InboardOutboard

Inboard/OutboardJet

Hull Material:

Max Speed:

Enhanced Performance Modifications (i.e., blowers, superchargers, etc.):

Trailer Coverage:

Purchase Year of Trailer:

Rating Base ($; include value of trailer and permanent/portable boating equipment if coverage is desired):

Underwriting/Discount Information

Primary Residence: 

Own a Home/Condo

Own a Mobile Home (10 yr   old or newer)

Rent

Live with Parents

Other

Association Name: 

None

USCG Auxillary

US Power Squadron

Dockage/Mooring/Storage ZIP Code:

Watercraft Use (i.e., pleasure, business, etc.):

Multi-Owner (more than one owner, not in the same household):

Prior Boat Insurance:

yes  no

If Yes, Prior Insurance Carrier:

Expiration Date:

 Discounts (select all that apply):

Safety Course

Transfer

Coverage Information 

Hull Deductible (Comp & Collision):

Liability Coverage Limits:

 Uninsured/Underinsured Boater Coverage:

Medical Pay Coverage:

Primary Personal Effects Coverage:

Fishing Equipment Coverage (Primary):

Emergency Towing (on-water):

Coastal Navigation:

125 Nautical Miles

Roadside Assistance: