Broker - Boat Application
Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.
Personal Information
Ownership Information
Corporately Titled? *
Residence Status *
Marital Status *
Agent You are Working With? *
Boating History & Experience
Have You Owned Boats Before? *
Any Boating Claims? *
Boating Courses? *
Vessel Information
Hull Material *
Hull Type *
Fuel Type *
Engine Type *
Number of Engines *
Additional Equipment - Please Check All That Are Onboard The Vessel *
Hold down the Ctrl Key to make multiple selections.
Is the Vessel Currently Insured? *
Mooring Location and Vessel Navigation and Usage
Where Do you keep the Vessel *
Storage Type *
Marina / Storage Name & Location: *
Is there a secondary storage location? *
Vessel Use *
Primary Navigation *
Additional Navigation / Mooring / Storage Notes: *
Coverage Section
Hull Deductible (% of Insured Value) *
Liability Limit *
Uninsured Boater *
Medical Payments *
Personal Effects *
Fishing Equipment *
Trailer Coverage *
Date Coverage is Needed *
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Additional Coverage Information *
Important NoticeAny
submissions or payments made via this website do not constitute a
binding agreement to your policy or coverages. Changes and
payments to policies are not effective or binding until you, or any
party involved, receive official notice from either your insurance agent,
or your insurance company. If you have any questions, please feel free to
contact us. Per the terms of our
online privacy policy we will not resell your information to any third-party.
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