Marine Quote Form

Your e-mail Address
(the quote will be emailed to this address)

Primary Storage/Moorage Location

Is vessel stored/kept at the residence?YesNo

Zip Code
If the vessel is not stored/kept at the residence, please provide us with the zip code where it is stored/kept. If in coastal area, it is important that you provide us with the zip code of the vessel location. Some insurance companies rate based only on the zip code and there are areas on the coast where one zip code vs another in the same city can cause dramatic differences in premium. If you only give us the city, our system will select the highest rate for that city.

Moorage ZIP Code:
(preferred)

*or* Moorage City:

Quick Quote Qualifications

Has the insured had any boating losses in the last 5 years?YesNo

Does the insured live more than 4 hours from vessel?YesNo

Is the boat used as the insured's primary residence?YesNo

Is the hull material other than fiberglass or aluminum?YesNo

Has the insured had a DUI, reckless driving or any driving violations
(including at fault accidents) in the last 3 years?YesNo

How many title owners?1 owner2 owners3 owners4 owners5 or more owners
Husband and wife only count as 1 owner.

Years Experience

Number of Years Boating Experience?
(if new to boat ownership but have boated with friends or family or have rented boats, include this in the answer.
Examples: Insured has boated with family for 2 years then they have two years experience or if they have rented
boats for 5 years then they have 5 years experience.)

Number of Years Boat Ownership?
If no prior ownership, input 0.

Vessel Information

Boat TypeAirboatBass boat/ WalleyeCruiserHouseboatPontoonRunaboutSailboatSki BoatSportfishingTrawler

Year

Length

Make

Vessel's Top Speed

Use of VesselPleasure use onlyOther

Coverage Requested

Vessel Value
(for liability only use 0)

Trailer Value
(for liability only use 0)

Liability Coverage$300,000$500,000$1,000,000

Medical Coverage$5,000$10,000$25,000

Insured's Information

Is the boat titled in a company name?YesNo

Does the insured have an existing boat insurance policy on this boat or any boat?YesNo
For the most accurate quotation use the proper first name (Robert vs. Bob) and resident address. Information is verified
using name and resident address. Incorrect or made up information will not produce the best premium available.

First name
use proper name Robert vs. Bob

Last name

Resident Address
information is verified using the resident address, an incorrect
or business address will not provide the best premium available.

City

StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

ZIP

Date Of Birth?
please use format (mm/dd/yyyy)

Boating CourseNoneUSCG CourseUSCG AuxiliaryUSPSCaptain

Social Security Number
Not required but recommended to provide a more accurate quote

Additional Vessel Information

Number of EnginesNo Engine1 Engine2 Engines3 Engines4 or more Engines

Type of Engine:InboardInboard/OutboardOutboardJet

FuelGasDiesel

Gasoline Fume Detector InstalledYesNo

Automatic Firefighting System in Engine CompartmentYesNo

How many years has the insured owned this vessel?0 (New Purchase)12345678910 or more

What is the Length of the largest prior boat owned by the insured?
If no prior boats, input 0.

Lay Up
This is the time period the vessel is not used (winter months) and a reduction of premium is applied. The vessel can be laid up ashore or afloat. The vessel is fully covered during a stated lay up period if it is not navigated, is not ready for immediate use and is not used to live aboard.

Select the number of months the vessel is laid upNo lay up1 month2 months3 months4 months5 months6 months

Enter the starting month the vessel enters lay upJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
Only required if laid up 1 or more months

Enter the starting day the vessel enters lay up12345678910111213141516171819202122232425262728293031
Only required if laid up 1 or more months

Is the vessel laid up Ashore or Afloat?AshoreAfloat

Navigation Information

Navigational Area
Inland Lakes and Waterways excluding Great Lakes and tidal waters (Southern)Florida Coastal WatersGulf Coastwise between Carrabelle, FL and Brownsville, TX

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