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Please fill out the following information and you will receive a quote within the next 24 hours

* Required Fields

About You

First Name*

Last Name*

Requested effected date of policy

Reffered By

Corporate Owner (if applicable)

Mailing Address

Street Address

City

State

Zip Code

E-mail Address

Phone Number

About Your Boat

Boat Year*

Boat Make*

Boat Model*

Boat Length*

Boat Weight (dry)

Hull Configuration

Construction

Purchase Date

Purchase Price

Estimated Value of Vessel*

Total Horsepower

Vessel's Top Speed (be honest)

Exposed Motor

If Yes, Is there a physical separation between engine and passengers?

Fume Detector?

Fixed Fire System?

About Your Boat's Engine(s)

Engine Make*

Engine Year*

Number of Engines*

HP per Engine*

Engine Type*

Fuel Type*

Principal Operator Information

Please fill out some information about the boat you are wanting to insure.

Birth Date*

Insured's Age

Years of Ownership Experience

Captain's License

Marital Status

Residence Status

Drivers License Number

Drivers License State

Drivers License Country

Clean Record?

Number of Speeding Tickets, Violations, etc.

DUI/OUI (past 5yrs)

Occupation

Boating Certificates

Explain Circumstances surrounding any loss:

Have you had any boating losses?

How Many?

Date of Loss

Amount of Damage

Amount paid by insurance

Information For Use of Vessel

Storage Information

Storage Mooring Location

Storage Mooring Address

City

State*

Zip

Where is the boat stored?

Moored at Residence

Usage Information

Broad Navigation

Coastal Use

Areas of Navigation

International Waters

Lay Up Start Date

Lay Up End Date

Date of Last Survey

Is primary nature commercial?

Used for Charter?

Number of Charters per Year

Description of Charter Business

Paid Crew

Information for Insurance Coverage Requested

Requested Hull Coverage

Hull Deductible Option

Or Standard Ded. Amount

Trailer Value

Trailer Year

Trailer Make

Requested Liability or P&I limit:

Additional Coverage Comments

Medical

Personal Property

Uninsured Boaters

Towing

Vessel Serial #

HIN

Trailer VIN

Engine Serial(s)

Tender Information (Yachts Only)

Dingy Amount

Dinghy Year

Dinghy Make

Dinghy Length

Dinghy Motor

Dinghy HP

Dinghy HIN

Dinghy Outboard Serial

Prior Boats Owned

Please add the length, Make, Year, Speed & Years Owned.

Select how many prior boats owned

Boat 1

Make

Model

Year

Length

Top Speed

Years Owned