Thursday, November 06, 2008   Home Our Products About Us Contact Us Quotes/Services Companies Links Glossary
Select a different form Life Insurance Quote Watercraft Quote Motorcycle Quote Other Quote Automobile Change Homeowners Change Other Change Auto ID Cards Certificates Billing Inquiry Contact Us	Watercraft Quote Request Please note: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member. Effective Date: Your Name: Your Mailing Address: Street City & State                                  Zip    E-mail Address: Daytime Phone #: Choose One: Please call me with quote premium. Please send quote via e-mail. Description of Property: Motor type: Outboard Inboard Outdrive Water jet Number of Engines: Twin Single None Boat Type: Sail Power Other Other Boat Type Fuel: Gas Diesel None Maximum Speed: Hull Material: Fiberglass Steel Wood Aluminum Other Other Hull Material: Insured Watercraft: Boat: Year   Manufacturer                  Model Serial Number                           Length TotalHP Outboard Motor: Year         Manufacturer                    Model Serial Number                                 TotalHP Trailer: Year         Manufacturer            Serial Number Coverages:   Limits: Boat (Including Auxiliary Equipment, please break down o/b information) Outboard Motor 1. (ACV Coverage) Outboard Motor 2. (ACV Coverage) Boat Trailer Personal Property ($500 Automatic) Commercial Towing ($400 Automatic) Boat Liability (ACV Coverage) $300,000 $500,000 $1,000,000 Medical Payments ($1000 Automatic with Liability) Automatic only $Limit 1 $Limit 2 $Limit 3 Uninsured Boater Optional Coverages Agreed Value Endorsement Actual Cash Value Fishing Equipment - Limit:   Safety Equipment: Check all that apply: GPS Automatic CO2 (Halon) Ship to Shore Radio (VHF) Depth Sounder Electronic Burglar Alarm Radar Plotter EPIRB Vapor Detector Alarm Operator Information: Date of Birth: Years of Boating Experience: Waters to be Navigated: Inland waters of the following states: Coastal waters of the following states: Is the boat chartered or used for other than private pleasure purposes?    Yes     No Previous Loss Information Please describe any losses or claims filed on your Boat Insurance in the last 3 years. Please include the date and type of the loss, as well as the amount of the claim Additional Comments Please use the box below to enter any additional information you wish to include: If you have not received a response from us within one business day, please contact us again. Thank you.
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