Boat Insurance Quote Form Boat Owners Quote Form We would love to hear from you! Please fill out this form and we will get in touch with you shortly. 1 General Information2 Boat Information3 Coverages Named Insured:Mailing Address:City:State:IllinoisIndianaIowaMissouriOhioWisconsinZip/Postal:Email:* Phone:Fax:Marital Status:MarriedSingle Age of Insured Person:# of years of boat ownership:Registered State:Mooring State:Mooring Zip Code:Year of Boat:Make and Model:Power Type:I/OInboardOutboardSailJetoutboardJetNo EngineLength (in feet):Number of Engines:Horsepower per engine:Hull Material:Top Speed:Coverage AmountsHow much coverage on inboard or I/O boat hull and motor:How much coverage on outboard boat hull:How much coverage on outboard motor:How much coverage on boat trailer:How much coverage for trolling motor:Any Protection Devices (Describe): Deductible:$100$250$500$100Towing:YesNoMedical Coverage:$500$1000$2000$5000Uninsured Watercraft Liability:YesNoNumber of Additional Owners:Any accident marine or other motorized vehicle last 3 years? If yes, please explain below:YesNoAny accident marine or other motorized vehicle last 3 years? If yes, please explain below:YesNoMinor violations (Boat or Auto)? If yes, please explain below:YesNoHave you taken the boater safety course?:YesNoHave you had boat insurance the last 12 months?:YesNoADDITIONAL INFORMATIONNOTICE: Some companies use an insurance score. This can often improve your rate. If you would like us to use this underwriting tool please provide us your social security number above in the dedicated box or in the remarks box below. (Rules of the Fair Reporting Credit Act and Federal Consumer Credit Protection Law, will apply)Please use this section to explain any violations, accidents or claims/losses.PhoneThis field is for validation purposes and should be left unchanged.