BOAT/JET-SKI QUOTE SHEET
WHEN DO YOU WANT THIS QUOTED POLICY PERIOD TO BEGIN?

NUMBER OF PEOPLE WHO OPERATE THE WATERCRAFT

(DO NOT INCLUDE HOUSEHOLD OPERATORS UNDER THE AGE OF 18):

OPERATOR(S) WITH ONLY A FORIEGN OR INTERNATIONAL DRIVERS LICENSE? YES NO

PRIMARY RESIDENCE:

HAVE YOU MOVED WITHIN THE PAST 60 DAYS? YES NO
ARE YOU A CURRENT POLICY HOLDER? YES NO
WATERCRAFT CO-OWNED BY SOMEONE LIVING IN A SEPERATE HOUSEHOLD? YES NO
ZIP CODE FOR THE PRIMARY STORAGE/MOORING LOCATION OF YOUR WATERCRAFT
PRIMARY USE:
WATERCRAFT INFORMATION

MODEL YEAR

MAKE:

MODEL:

WATERCRAFT HULL LENGTH(ROUND TO THE NEAREST FOOT)

TOTAL HORSEPOWER OF ALL OF THE MOTORS ON THE WATERCRAFT? (IF MORE THAN ONE MOTOR, ADD THE HORSEPOWER OF ALL MOTORS TO DETERMINE TOTAL)
PROPULSION TYPE:

ENGINE/OUTDRIVE MODIFIED TO ENHANCE PERFORMANCE? MODE YES NO

HULL MATERIAL:
VALUE OF WATERCRAFT? (ENTER NUMERIC CHARECTERS ONLY, EXAMPLE 15000
DOES THE VALUE INCLUDE A TRAILER? YES NO
DRIVER INFORMATION
 FIRST NAME: MIDDLE I. LAST NAME:
NAME SUFFIX (EXAMPLE JR.) BIRTH DATE

SOCIAL SECURTY NUMBER

GENDER MALE FEMALE
MARITAL STATUS: SINGLE/ SEPERATED MARRIED/ WIDOWED
DRIVER LICENSE STATUS
MAILING ADDRESS CITY
STATE ZIP CODE
PREVIOUS MAILING ADDRESS CITY
STATE ZIP CODE
VIOLATION INFORMATION

INCIDENT INFORMATION

DATE OF INCIDENT

INCIDENT INFORMATION

DATE OF INCIDENT

INCIDENT INFORMATION

DATE OF INCIDENT

 

PLEASE SELECT THE COVERAGE YOU WISH TO CARRY. IF YOU HAVE QUESTIONS REGUARDING A SPECIFIC COVERAGE, E-MAIL ON THE E-MAIL LINK
BODILY INJURY & PROPERTY DAMAGE (BI/PD):

UNINSURED BOATERS BODILY INJURY (UB):

MEDICAL PAYMENTS (MED PAY) COVERAGE:

PHYSICAL DAMAGE OPTIONS:
COMPREHENSIVE (COMP) COVERAGE:
COLLISION (COLL) COVERAGE:
FISHING EQUIPMENT (FISHEQP) COVERAGE:
ON-WATER TOWING (TOW) COVERAGE:
REPLACEMENT COST PERSONAL EFFECTS (PE) COVERAGE:
CONTACT INFORMATION
E-MAIL ADDRESS: (ADDRESS THAT WILL BE USED TO SEND YOUR RATE INFORMATION)
PHONE NUMBER: