Free Quote - InsureTheBoat.com

APPLICANT

Name*

First Last

Address

Street Address Address Line 2 City State ZIP Code

Email*

Enter Email Confirm Email

Phone

Date of Birth

Marital Status

Years Experience

Years Owned

PRIOR VESSELS OWNED / OPERATED

BOAT 1: Length in Feet

BOAT 1: Make

BOAT 1: Years Owned

BOAT 2: Length in Feet

BOAT 2: Make

BOAT 2: Years Owned

VESSEL BEING QUOTED

Year

Manufacturer

Length in Feet

Model

HIN

Purchase price or requested insurance value

Hull Material

Mast

Electronic on board

GPS
VHF/SS Radio
Depth
Radar
Loran
* Full-Time Live Aboard

Safety Equipment

Fume Detector
Automatic Extinguiser/Halon
Other

Other

Is boat being quoted currently insured by you?

Yes
No

If boat has been surveyed by you, date of Survey.

Current Insurance Company

ENGINE

Type

Total HP

Top Speed

Fuel

Number of Main Engines

Liability Limit

($500,000 recommended for boats 30ft and up)

TRAILER

Year

Value

MOORING LOCATION, NAVIGATION, LAY UP

Summer Location Name

Summer Location Address

Street Address Address Line 2 City State ZIP Code

Winter Location Name

Winter Location Address

Street Address Address Line 2 City State ZIP Code

Waters Navigated

Lay Up

ADDITIONAL INFO

Paid Captian?

No
Yes

Paid Crew?

No
Yes

Charter?

No
Yes

Type of Charter

Claims History

# of Claims UNDER $5,000

# of Claims OVER $5,000

Date of Claim*

Cause of Claim*

Amount Paid*