binder | Boater's Insurance Agency

Request For

Select desired requests Binder to Dealer Quote to Dealer Quote to Client

Dealer Information

Dealership name

Phone

Fax (optional)

Email

Contact's name

Owner Information

Owner 1

First name

Middle initial

Last name

Date of birth (mm/dd/yyyy)

Owner 2

First name

Middle initial

Last name

Street address

Zip

City

State

Phone

Work phone (optional)

Cell phone (optional)

Email

Years of boat operating experience

Years of boat ownership

Boat Info

Year (yyyy)

Length (ft)

Manufacturer

Model

Serial number

Boat & Engine(s) Insured Value, including TT&L ($)

Engine Information

Engine 1

Make

Year (yyyy)

HP

Serial number

Engine 2

Make

Year (yyyy)

HP

Serial number

Trailer Information

Year (yyyy)

Make

Number of axles

Serial number

Insured Value including TT&L ($)

General Information

Loss Payee, Lender

Effective date (mm/dd/yyyy)