Insurance is available in Georgia (GA, South Carolina (SC), North Carolina (NC), and Tennessee (TN) and Virginia (VA)
Please take a moment to tell us about your boat and where you use it. If you have any special needs or requirements, or would rather obtain a quote by phone, please call one of our agents at (252) 974-7737 or toll free at (866) 274-2455.
**We currently only insure boats used for pleasure. We do not insure commercial boats. |
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| Boat Value: |
(include boat, motor, and trailer in value) |
| Will the boat be used primarily for fishing?
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| Please select the type of water way most often used.
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Is this boat owned by a corporation?
(The boat is titled/registered to an incorporated business rather than one or more individuals.) |
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| Primary Owner Information |
| First Name:
Middle Initial:
Last Name:
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| Address: |
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| Phone Number:
(555-555-5555) Fax Number:
(555-555-5555) |
| Email Address:
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| Date of Birth:
Occupation:
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| How would you like to receive your quote?
Email
Mail
Phone |
| Primary Owner Experience |
| Years of boating experience:
Size of boats operated:
(In feet, list 3 boat sizes if applicable) |
| Years as a boat owner:
Size of boats owned:
(In feet, list 3 boat sizes if applicable) |
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| Boating Education:
None
USPS
USCGA
Other |
| Active Member:
USPS
USCGA
Coxswain
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| Driver's License No:
State of Issue:
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List any moving violations by Owner within the last 3 years. |
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Check here if no Violations and skip to Number of Owners |
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| Number of Owners, other than yourself:
Number of Regular Operators, other than yourself:
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| Watercraft Information |
| Builder:
Model:
Year:
Length:
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| Boat Name:
Purchase Date:
Purchase Price:
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| Number of Engines:
Engine Year:
Horsepower:
Top Speed:
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| Boat Hull Type:
Hull Material:
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| Power Type:
Fuel Type:
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| Has this boat ever been damaged?
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| If yes, please explain
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| Insured value:
Trailer Value:
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| Location |
| Boat Location:
Rack Storage
At Dock
On Trailer
On Mooring |
| Mooring Location:
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| Is this boat stored at your residence?
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| Marina Name or Boat Location:
(if applicable) |
| Marina or Boat Location Address:
(if applicable) |
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