Boat Quote Request Form First Name Last Name Email Address Phone Number Date of Birth Mailing Address Zip Describe your boat (length, horsepower, number of engines, sail/power, inboard/outboard, etc. Year Make Model Primary Use —Please choose an option—Pleasure UseRacing/Speed ContestsBusiness Commercial UseRented or Leased to othersPrimary Residence Watercraft Zip Location Was the vehicle purchased or leased? —Please choose an option—PurchasedLeased Are you the original owner of the vehicle? YesNo Is the watercraft co-owned by someone living in a separate household YesNo What year was this vehicle acquired Market Value of vehicle Would you like to insure your trailer? YesNo Gender MaleFemale Marital Status —Please choose an option—Single/SeparatedMarried/Civil Union/Domestic Partnership/Widowed Residency Primary Residence —Please choose an option—Own House/CondominiumOwn Manufactured HomeRentOther Moved in the last 2 months? —Please choose an option—NoYes - Moved within the U.S.Yes - Moved from outside the U.S. Driving History Driver's License Status —Please choose an option—ValidPermitSuspendedNot LicensedForeign Driver's License Years of Boat Operating Experience Taken an approved watercraft safety course? YesNo Accidents, Violations, and Claims As a driver in the last 3 years, have you had any of the following regardless of fault (including automobile) Accidents, claims, or other damages you had to a vehicle? YesNo Tickets or Violations YesNo Additional Information When would you need coverage?
