Recreational Insurance
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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
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
Zip
Driver Information
Driver 1
First Name
Last Name
Gender
Male
Female
Birth Date
Marital Status
Years Boating Experience
State Licensed
Occupation
Driver 2
First Name
Last Name
Gender
Male
Female
Birth Date
Marital Status
Years Boating Experience
State Licensed
Occupation
Driver 3
First Name
Last Name
Gender
Male
Female
Birth Date
Marital Status
Years Boating Experience
State Licensed
Occupation
Driver 4
First Name
Last Name
Gender
Male
Female
Birth Date
Marital Status
Years Boating Experience
State Licensed
Occupation
Boat Information
Boat
Year
Make
Model
Type
Identification
Serial Number
Cost New Value
Hours Used
Each Year
Boat Length
Watercraft Weight
Ownership
Lienholder
Trailer Information
Trailer
Year
Make
Model
Type
Identification
Serial Number
Cost New Value
Motor Information
Motor
Year
Make
Model
Type
Identification
Serial Number
Cost New Value
Horsepower or
Motor Size
Ownership
Deductible Information
  Boat & Motor Trailer
Comprehensive (Theft)
Collision
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.
Accidents - non chargeable
Accidents - chargeable
Major violations - drunk driving, reckless, hit and run, etc.
Coverage Information
  Bodily Injury Property Damage
Personal liability
Uninsured motorist
Medical payment  
Deductible Information
Vehicle 1
Comprehensive (Theft)
Collision
Vehicle 2
Comprehensive (Theft)
Collision
Vehicle 3
Comprehensive (Theft)
Collision
Vehicle 4
Comprehensive (Theft)
Collision
Miscellaneous Information
Does the Boat have a Fire System?
Any Commercial Usage?
What is the Fuel Type?
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:
     
 
V. H. JR., & ASSOCIATES, INC.

1435 W Busch Blvd. Ste. D | Tampa, FL 33612
Phone 813-931-5546
Fax 813-931-9137
 
 
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