Boat | Boater's Insurance Agency

Step 1 of 9

Owner Information

First Name

Middle Name

Last Name

Zip Code

Not a real zip code.

Street Address

City

State

Email

phone

Fax (optional)

Step 2 of 9

Boat Information

Vessel type

Boat builder

Boat model

Boat year (yyyy)

Boat length (ft)

Top speed (mph)

Select all of the equipment the boat has installed Depth Finder VHF Radio GPS Radar SATNAV CO-2 SSB Auto HALON Loran

Step 3 of 9

Engine Information

Engine make

Number of engines

Horsepower per engine

Engine year (yyyy)

Engine type

Fuel type

Step 4 of 9

Trailer Information

Do you have a trailer?

Yes No

Step 5 of 9

Mooring Information

Mooring storage/location

Zip

City

State

Hurricane response plan (if the boat is stored within 20 miles of the Gulf or Atlantic Coast)

Step 6 of 9

Experience

Date of birth (mm/dd/yyyy)

Occupation

Years of boating experience

Years of boating ownership

Previous boat owned

Boating safety classes Coast Guard Aux USPA Other

USCG Licenses 6-Pak 100 Ton

Please list any auto driving tickets, accidents, or DUIs past 3 years.

Please list boating claims, losses or accidents past 5 years.

Step 7 of 9

Step 8 of 9

Coverage Request

Date of purchase (mm/dd/yyyy)

Total purchase amount ($)

Boat and motor current value ($)

Liability amount ($)

Deductible

Note: Deductibles and Liability Limit will be quoted at closest amount available to amount selected

If more than two (2) unrelated owners, please explain

Other comments (optional)

How did you hear about Boater's Insurance?

Please send quote by

Step 9 of 9