April 25th, 2017
Boater's Insurance Agency... It's Our Only Business!

Boat Insurance Quote Form

Please fill out the form below to receive a quote. No Boats over 15 years of age accepted.

Boater's Insurance -Boat Quote
Owner Information
First Name:
MI:
Last Name:
Address:
City:
State:
Zip:
Phone:
() -
Fax Number:
() -
E-mail Address:
   
Boat Information
Year:
Length:
Builder:
Model:
Vessel Type:
Top Speed:
   
Engine Information
Year:
Make:
# Of Engines:
HP Each:
Type:
Fuel:
   
Trailer Information
Year:
Make:
No. of Axles:
   
Indicate Equipment / Safety Features Installed on Your Vessel:
Depth Finder VHF Radio SSB
GPS Radar Auto HALON
SATNAV CO-2 Loran
   
Mooring Information
Mooring/Storage Location:
Mooring City:
Mooring State:
Mooring Zip:
If the boat is stored anywhere in Florida or within 20 miles of the Gulf or Atlantic Coast, what is your hurricane response plan?:
Experience
Date of Birth:
Occupation:
Years of Boat Operating Experience:   Years of Boat Ownership:
Previous Boat Owned:  
Boating Safety Classes: Coast Guard Aux.   USPS   Other   
USCG Licenses:   6-Pak Charter    100 Ton   
Please list any auto driving tickets, accidents, or DUI's past 3 years:
Please list boating claims, losses or accidents past 5 years:
   
Is Boat to be used for Private Pleasure Only? Yes     No
Is there a Paid Skipper / Crew? Yes     No
Will this boat be used for Charter, Rental, or Leasing? Yes     No
Will this boat be used as a Residence or Live aboard? Yes     No
Do you have this boat currently for sale? Yes     No
Is this boat currently insured? Yes     No
If yes, name of insurance company: Expires:
Is this boat owned by a Corporation? Yes     No
If yes, provide legal name of Corporation:
Has this boat ever been damaged? Yes     No
If yes explain:
Has insurance ever been cancelled or refused? Yes     No
If yes explain:
Latest Survey Date:     In Water     Haul Out
   
Coverage Request
Purchase Date:   
Total Purchase Amount:
Boat & Motor Current Value:   Trailer Current Value:
Liability Amount: 100,000 300,000 500,000 1,000,000
Deductible: 1% 2% 3% 250 500 1,000

Note: Deductibles and Liability Limit will be quoted at closest amount available to amount selected

If more than one (1) unrelated owners please explain:
- Other Comments -
How did you hear about Boater's Insurance?   
Please Send Quote By: Email Fax Mail Phone


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