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Boat Insurance Quote
Completely fill out and submit this form to our agency to receive an accurate quote. You MUST provide at least one method of contact to receive a quote from our agency.

 Personal Information
  Name (required)  
 E-Mail Address (required)  
 Home Phone  
 Work Phone  

 First Name Birthdate Has Operator completed Coast Guard Auxiliary or Power Squadron course?

 Boat Information (ALL INFO REQUIRED)
 Boat Currently Insured?  
Policy Expires Month/Year
Current/Desired Policy Deductible  
 Boat Type
Where is vessel stored
 Waters Navigated  

 Used for Racing?


  Hull Type  
Estimated Market Value  
Year Built
 Max Speed (in MPH)  
 Personal Effects? (Amount)  
Misc Boating Equip? (Amount)  

 #1 Engine
 Make  Year
 Fuel Type
 Est. Value (O/B Only)
 Horse Power


#2 Engine

 Make  Year
 Fuel Type  
 Est. Value (O/B Only)
 Horse Power

 If Yes

 Liability Coverage
 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?  

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mail to: gkh@InsuranceQuote.net
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