Jet Ski Insurance Quote Form Jet Ski 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 Jet Ski Information3 Coverages Named Insured:Mailing Address:City:State:IllinoisIndianaIowaMissouriOhioWisconsinZip/Postal:Email:* Phone:Fax: Number of Jet Skis:Liability coverage only is available.Max Number of Passengers:Year:Make and Model:VIN:Where and how is the jet ski stored? Explain:Any Jet Ski over 14Ft In Length?:YesNoJet Claims or Losses? If yes, please explain below:YesNoAny Operator under 14?:YesNoIs Jet Ski Rented or Leased?:YesNoUse in Racing?:YesNoEngine or Pump Altered?:YesNoAny Policy Cancelled (Other than nonpay)?:YesNoEngine Displacement Unit (Total Cubic CM):0-600601-700701-850851-10991100+ Jet Ski Value:Trailer Value:Liability Limits:$20/40 BI / 15 PD$25 / 50 / 25$50 /100 / 25$50 / 100 / 50$100 / 300 / 50$100 /300 / 100Medical Coverage:$500$1000$2000$5000Uninsured Boatowners Liability:YesNoWatersport Liability:YesNoNumber of Owners:Any accident marine or other motorized vehicle? If yes, please explain below:YesNoMajor violations? If yes, please explain below:YesNoMinor violations? If yes, please explain below:YesNoSuspended license:YesNoHave you had insurance on a jet ski 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.NameThis field is for validation purposes and should be left unchanged.