Rogers Insurance Brokers Inc.

RIGHT FROM THE BEGINNING AN INDEPENDANT BROKER IS THERE TO MAKE THINGS RIGHT

 

3 Locations to Serve your Insurance Needs

Sundridge

88 Main Street

Sundridge, ON P0A 1Z0

Tel: (705) 384-7001

Fax: (705) 384-7337

Toll Free: 1-888-822-8484

Bracebridge

58 Dominion Street

Bracebridge, ON P1L 1W2

Tel: (705) 645-4731

Fax: (705) 645-3410

North Bay

41 Kodiak Cresent

North Bay, ON P1A 3S8

Tel: (705) 497-3409

Fax: (705) 497-0830

Toll Free: 1-800-526-7420

     

 E-mail: drinsure@onlink.net

 The following agencies are licensed to quote and write insurance policies only in Ontario. To find agents offering these coverage in all of the other states, please click our logo to the right.

 

Fill out this form and submit it to our agency to receive an accurate Boat Insurance Quote


 
 Personal Information
  Name (required)  
 E-Mail Address (required)  
 Address  
 City, Prov, PC  
 Home Phone  
 Work Phone  
 Fax  
 Operators
 First Name Birthdate Has Operator completed Coast Guard Auxiliary or Power Squadron course?
#1    
#2
#3    
 Boat Information
 Boat Currently Insured?  
Policy Expires Month/Year
 Boat Type
 Use
Where is vessel stored
 Hull
 Make/Model  
  Hull Type  
 Length  
Estimated Market Value  
Year Built
 Max Speed (in MPH)  
   
 Engine(s)
 #1 Engine
 Make  Year
 Type  
 Fuel Type
 Est. Value (O/B Only)
 Horse Power

 

#2 Engine

 Make  Year
 Type  
 Fuel Type  
 Est. Value (O/B Only)
 Horse Power
 Trailer?
 If Yes
 Make  
 Value  
 Liability Coverage
 Liability  
 Medical Payments  
 Water Ski Medical Needed  
 Explain all yes answers below
Has any listed operator been involved in a boating accident within the past 5 years?  
Has your boat and / or equipment suffered damage from any cause within the past 5 years ?  
Has any listed operator been involved in an auto accident or received a moving traffic citation in the past 3 years?  
  Remarks
 


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© Gordon K. Harden, Jr. 1996-99
mail to: gkh@InsuranceQuote.net
 
Page Created 2-22-99
 
Revised