Please note: No new coverage is in effect until you receive confirmation of such from our office.x Your Name * Your Mailing Address * Street City * State * Zip * E-mail Address * Daytime Phone Number * Your Watercraft: If you have more than one watercraft, please call our office for a quote. Year * Manufacturer & Model * Serial # (if known) * Length * Total Horsepower * Value * Power: * Please select one Inboard or Inboard/Outdrive Personal Watercraft Outboard Sailboat Other Max Speed (mph) * Hull Type: * Please select one Cabin Cruiser Sailboat Open Cockpit House Boat Pontoon Boat Bass Boat Wave Runner/Jet Ski Inflatable Hull Material: * Please select one Fiberglass Metal/Aluminum Wood Rubber Water Navigated: * Please select one Coastal Waters Great Lakes Inland Lakes/Rivers Only Number of Outboard Motors: * Please select one 1 2 3 Outboard Motor 1 Year * Horsepower * Manufacturer * Serial # (if known) * Value * Outboard Motor 2 Year * Horsepower * Manufacturer * Serial # (if known) * Value * Outboard Motor 3 Year * Horsepower * Manufacturer * Serial # (if known) * Value * Boat Operator Number of Boat Operators: Please select one 1 2 3 4 Operator 1 Name DOB Marital Status Please select one Married Single Boater licensed for 2 or more years? Yes No Completed a safety course in the past 3 years? Yes No Operator 2 Name DOB Marital Status Please select one Married Single Boater licensed for 2 or more years? Yes No Completed a safety course in the past 3 years? Yes No Operator 3 Name DOB Marital Status Please select one Married Single Boater licensed for 2 or more years? Yes No Completed a safety course in the past 3 years? Yes No Operator 4 Name DOB Marital Status Please select one Married Single Boater licensed for 2 or more years? Yes No Completed a safety course in the past 3 years? Yes No Trailer Year * Manufacturer * Serial # (if known) * Value * Coverages Deductible: * Please select one $100 $250 $500 $1,000 $2,500 $5,000 Liability: * Please select one $25,000 $50,000 $100,000 $200,000 $300,000 $500,000 Medical Expense (others): * Please select one $1,000 $2,000 $5,000 Medical Expenses (insured): * Please select one $1,000 $2,000 $5,000 Un-insured Coverage: * Please select one None $10,000 $25,000 Equipment * Bilge Pump Fume Detector CO2 / Halon Depth Finder Radar Loran / GPS Ship to Shore Radio / VHF Completed a U.S. Power Squadron or U.S. Coast Guard Auxiliary course? * Yes No Additional Comments Please use the box below to enter any additional information you feel should be considered: Protecting your privacy and identity is very important to us. Your Social Security and drivers license numbers may be required to complete this quote. We will contact you personally for this information. reCAPTCHA Submit