Florida Boat Insurance Quote

Full Name:            
Mailing Address:
City:
Florida
Zip Code:
Email Address: (Required) 
Home Phone:   Work Phone:   Ext.
How to Contact You: Select One Phone at Work Phone at Home Cell Phone Email       Cell Phone:
Date of Birth:              (mm/dd/yyyy)
Gender: Select One Male Female         Marital Status: Select One Married Single Single with Child
Current Insurance Company: 
Policy Expiration Date:          (mm/dd/yyyy)

Florida Boater Information:

  Boat       Year          Builder               Model            Vessel Type     Length
     1         Select One Cruiser Motor Yacht Sport Fisher Trawler Sail Runabout Other
     2         Select One Cruiser Motor Yacht Sport Fisher Trawler Sail Runabout Other

Boat Engine Information:
  Boat       Year       Engine Type       Manufacturer         # of Engines   Engine HP
    1        Select One Inboard I/O Outboard Inboard Jet Outboard Jet V-Drive Other    Select One 1 2 3  
    2        Select One Inboard I/O Outboard Inboard Jet Outboard Jet V-Drive Other    Select One 1 2 3  

Boat Trailer Information:
  Boat       Year          Builder               Model                Value
     1          
     2          

Mooring/Storage Location
  Boat
     1       Select One Home - Garaged Home - Side Yard Home - Private Dock Marina - Berthed Marina - Trailered Marina - Dry Stack Storage Facility - Indoor Storage Facility - Outdoor Other
     2       Select One Home - Garaged Home - Side Yard Home - Private Dock Marina - Berthed Marina - Trailered Marina - Dry Stack Storage Facility - Indoor Storage Facility - Outdoor Other

What types of safety equipment is on your vessel(s)?
(check as many boxes as desired)
  Boat
     1   VHF    Depth Finder    SAT NAV    Auto Halon
          EPIRB    SSB    GPS    Radar
          Loran    CO-2    Fume Detector    Other
     2   VHF    Depth Finder    SAT NAV    Auto Halon
          EPIRB    SSB    GPS    Radar
          Loran    CO-2    Fume Detector    Other

Value of waterskiing and/or fishing equipment:

Is boat used on any private lakes?
  Boat
     1       Select One Yes No
     2       Select One Yes No

Is boat used in bay and/or coastal waters?
  Boat
     1       Select One Yes No
     2       Select One Yes No

Is boat used outside U.S. coastal waters?
  Boat
     1       Select One Yes No
     2       Select One Yes No

Is this a promotional/Memo boat?
  Boat
     1       Select One Yes No
     2       Select One Yes No

Is boat used for guide service or chartering?
  Boat
     1       Select One Yes No
     2       Select One Yes No

Is boat used for residence?
  Boat
     1       Select One Yes No
     2       Select One Yes No

Is boat used for waterskiing?
  Boat
     1       Select One Yes No
     2       Select One Yes No

Is your driving record accident & violation
free during the past 5 years?  Select One No Yes
If No, how many accidents?    How many violations? 

Boat Insurance Coverages Desired For?
(check as many boxes as desired)
Boat(s)    Motor(s)    Equipment    Trailer

Florida Boat Insurance Coverage Information:

                    Liability                  Uninsured
  Boat    Limits(x $1,000)      Boater(x $1,000)       Medical
     1       Select One $100,000 $300,000 $500,000 $1 million         Select One None $100,000 $300,000 $500,000 $1 million        Select One None $1,000 $2,000 $5,000 $10,000
     2             SAME                       SAME                   SAME

                   Collision         Comprehensive
  Boat       Deductible           Deductible
     1        Select One None $100 $250 $500 $1,000 $2,500 $5,000       Select One None $100 $250 $500 $1,000 $2,500 $5,000
     2        Select One None $100 $250 $500 $1,000 $2,500 $5,000       Select One None $100 $250 $500 $1,000 $2,500 $5,000
List any boating safety education courses completed:


Any boating claims of losses to vessel(s) or
from liability in the past 5 years? Select One Yes NO
Description of losses:


Additional Information or Comments


Click on the "Submit Quote Request" button below to
send your Florida Boat insurance quote request.**

**Information received from this Florida Boat Insurance quote request form sent to "YOUR AGENCY NAME" will be for our use only and will not be sold, given to or distributed to any other parties. A quote will be based on the Florida boat insurance policy information provided and does not guarantee acceptance of the risk by us. The precise coverage afforded is subject to meeting underwriting guidelines, and the terms, conditions and exclusions of the policy as issued. By submitting this request you acknowledge that this is neither an offer to insure nor a guarantee of insurance. Completion of this form does not entitle you to a Florida Boat Insurance policy. We are licensed in Florida and will not provide boat insurance quotes for other states.

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