Secured Page
BOAT INSURANCE QUOTE REQUEST
Complete the following information if you would like to obtain a quote on a Boat insurance policy. Please understand this is not an application for insurance. An application will be sent to you if coverage is desired.
All information provided on this information sheet is confidential and will be used solely for the purpose of developing a quote for you.
For all inboard, outboard, high performance, water-ski boats, yachts, and sail boats, large or small if used for pleasure.
Garaging Information
What is your name?
Last
First
Middle
What is the garaging address?
Street
City
State
Select
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Washington, DC
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Zip
What is your telephone number?
Home
Work
What is your fax number?
Fax
What is your email address?
Email
Mailing Address
What is your mailing address? (if different from above)
Street
City
State
Select
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Washington, DC
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Zip
Driver Information
Driver 1
First Name
Last Name
Gender
Male
Female
Birth Date
Marital Status
Select
Single
Married
Divorced
Widowed
Separated
Years Boating Experience
State Licensed
Occupation
Driver 2
First Name
Last Name
Gender
Male
Female
Birth Date
Marital Status
Select
Single
Married
Divorced
Widowed
Separated
Years Boating Experience
State Licensed
Occupation
Driver 3
First Name
Last Name
Gender
Male
Female
Birth Date
Marital Status
Select
Single
Married
Divorced
Widowed
Separated
Years Boating Experience
State Licensed
Occupation
Driver 4
First Name
Last Name
Gender
Male
Female
Birth Date
Marital Status
Select
Single
Married
Divorced
Widowed
Separated
Years Boating Experience
State Licensed
Occupation
Boat Information
Boat
Year
Make
Model
Type
Select
Sail Boat
Ski Boat
Pontoon Boat
House Boat
Cabin Cruiser
Bass Fishing Boat
Flat Bottom
Tunnel Hull
Pickle Fork
Identification
Serial Number
Cost New Value
Hours Used
Each Year
Select
Under 50
51-100
101-200
201-300
301-400
401-500
500+
Boat Length
Watercraft Weight
Ownership
Select
Leased
Paid-Off
Financed
Lienholder
Select
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Washington, DC
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Trailer Information
Trailer
Year
Make
Model
Type
Select
Single Axle
Dual Axle
Three Axle
Identification
Serial Number
Cost New Value
Motor Information
Motor
Year
Make
Model
Type
Select
No Motor
In-Board
Out-Board
In/Out-Board
Identification
Serial Number
Cost New Value
Horsepower or
Motor Size
Ownership
Select
Leased
Paid-Off
Financed
Deductible Information
Boat & Motor
Trailer
Comprehensive (Theft)
Select
No Coverage
250
500
1,000
1,500
2,000
Select
No Coverage
250
500
1,000
1,500
2,000
Collision
Select
No Coverage
250
500
1,000
1,500
2,000
Select
No Coverage
250
500
1,000
1,500
2,000
Violation Information
Last 3 years (minor violations)
Last 5 years (major violations)
Driver 1
Driver 2
Driver 3
Driver 4
Minor violations - speeding, turn, stop sign, red light, etc.
None
1
2
3
4
None
1
2
3
4
None
1
2
3
4
None
1
2
3
4
Accidents - non chargeable
None
1
2
3
4
None
1
2
3
4
None
1
2
3
4
None
1
2
3
4
Accidents - chargeable
None
1
2
3
4
None
1
2
3
4
None
1
2
3
4
None
1
2
3
4
Major violations - drunk driving, reckless, hit and run, etc.
None
1
2
3
4
None
1
2
3
4
None
1
2
3
4
None
1
2
3
4
Coverage Information
Bodily Injury
Property Damage
Personal liability
Select
15,000/30,000
25,000/50,000
50,000/100,000
100,000/300,000
250,000/500,000
Select
5,000
10,000
25,000
50,000
100,000
Uninsured motorist
Select
No Coverage
15,000/30,000
25,000/50,000
50,000/100,000
100,000/300,000
250,000/500,000
Select
None
3,500
Deductible Waiver
Medical payment
Select
None
1,000
2,000
2,500
5,000
10,000
15,000
20,000
25,000
50,000
100,000
Deductible Information
Vehicle 1
Comprehensive (Theft)
Select
No Coverage
50
100
250
500
750
1,000
Collision
Select
No Coverage
100
250
500
750
1,000
1,500
2,000
Vehicle 2
Comprehensive (Theft)
Select
No Coverage
50
100
250
500
750
1,000
Collision
Select
No Coverage
100
250
500
750
1,000
1,500
2,000
Vehicle 3
Comprehensive (Theft)
Select
No Coverage
50
100
250
500
750
1,000
Collision
Select
No Coverage
100
250
500
750
1,000
1,500
2,000
Vehicle 4
Comprehensive (Theft)
Select
No Coverage
50
100
250
500
750
1,000
Collision
Select
No Coverage
100
250
500
750
1,000
1,500
2,000
Miscellaneous Information
Does the Boat have a Fire System?
Select
No
Yes
Any Commercial Usage?
Select
No
Yes
What is the Fuel Type?
Select
Gas
Diesel
List Electronic Aids in the Boat.
What is the Current Insurance Company?
What is the Policy Expiration Date?
What is the Current Premium?
Questions or Comments.
Best Time to Contact You
Please let us know the best time to call and discuss your quote.
Morning
Afternoon
Evening
Anytime
Or specify other:
The Schwab Agency
714 Centerpark Drive, Suite 100 | Colleyville, TX 76034
Phone 817-485-5050 or toll free 877-485-5090
Fax 817-485-5070
