Insurance Score / Claim History Disclosure

In connection with this application for insurance, we may review your credit report or obtain or use a credit-based insurance score based on the information contained in that credit report. We may use a third party in connection with the development of your insurance score. In connection with this application for insurance, we may review your claims history or loss experience and may report future claims made by you to a claims history provider.

Applicant agrees to these terms. *    

Boat Quote Request

When you fill out and submit this form, one of our agents will take your information and provide you a quote
within two business days. If you would like an immediate quote, call 1-866-884-6167 Mon - Fri 8 a.m. - 8 p.m ET.

This form allows you to provide information for one boat. If you have two or more boats, we can insure
them – just call us!

All fields marked with an asterisk are required. You may find it useful to have your current policy
or declarations page handy.

How did you hear about us? *    

Boat Information

Model Year: *    
Select the boat type:    
Length (in feet): *    
Manufacturer: *    
Model: *    
Horsepower: *    
Maximum Speed:    
Current market value (including motor):    
What is the weight of your boat (in pounds)?    
What type of engine powers your boat? *    
Number of Engines:    
1       2       3       4      
If the boat is moored, please provide the zip code
of its location:    

Coverages and Limits

We offer liability only and full coverage policies. Which
do you prefer? *    
Liability Only       Full Coverage      
Select your desired amount of liability coverage.
The numbers represent the amount of coverage on
the policy per person/per accident/per occurrence.
Higher and lower limits are available, but these are
the most common. *    
Full coverage policies can also protect trailers, boat lifts
and tenders/dinghies. If you need coverage for one or
more of these on your policy, select all that apply here:    
Trailer       Boat Lift       Tender/Dinghy      
Please tell us the amount of coverage you want for your
trailer/tender/dinghy/boat lift.    
Do you have experience operating boats?    
If yes, how many years of boating experience do you have?    
Is the boat/PWC currently insured? If so, you may qualify
for a discount. *    
Yes       No      
If yes, who is your current insurance company?    
Do you insure your boat with a separate/standalone policy,
or do you endorse your boat onto your homeowners
or auto insurance policy?    
Have you had any losses or claims on this boat/PWC in the
last three years? *    
Yes       No      
Have you been involved in any water-related violations in
the last three years? *    
Yes       No      
In the last three years, have you had any minor
or major moving violations that are not watercraft related? *    
Yes       No      

Please provide the following information so we can contact you with your quote.
We respect your privacy and will never sell or rent your contact information to third parties.

First Name: *    
Last Name: *    
Date of Birth (mm/dd/yyyy): *    
Address: *    
City: *    
State/Province: *    
Zip Code: *    
We apologize that coverage is not available in New York.

How would you prefer that we contact you? *    
Daytime Phone       Alternate Phone       E-mail      
Daytime Phone Number:    
Alternate Phone Number:    
Best Time to Contact    
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