Boat/Yacht Insurance Quote Form

Welcome to our Boat/Yacht insurance quote form.  If currently insured, your policy's declaration page will have much of the needed information.  Your information will be emailed to one of agents.  All information entered is confidential.

DO NOT USE THE "ENTER" KEY

USE THE "TAB" KEY  

OR YOUR MOUSE

TO MOVE FROM FIELD TO FIELD.
 
 
Contact Information
Name:  
Address:  
County:
City:  
State:
Zip Code:  
Daytime phone:  
Evening Phone:
FAX:
Email Address:  

 

Insurance Policy Information

 Name of present Insurance Company 

Policy Expiration Date:

Length of time with this insured:

If less than six months, please explain:

 

Driver Information
Drivers

Driver #1

 Driver #2
First Name
Date of Birth (mm/dd/yy)
Martial Status
Gender M    F M     F
Occupation
Social Security #

An Insurance Score is required for an accurate quote.  Please call us at 215-860-0400 if you do not wish to provide your SS# over the internet.
Drivers License #

Describe tickets and license suspensions

Example: Driver #1 - 12/99 Speeding - going 75 in a 55 zone
Tickets in last 5 yrs.

Describe accidents with date and amount of damage your insurance company paid

Example: #1-12/99, I hit other driver in rear, my company paid $7,500
Accidents in last 5 yrs.
Safety Courses Completed.

 

Information Boat/Yacht
Year:
Make
Model
Serial Number
Length of Boat
Type of Engine (inboard, outboard, I/O)
Type of Fuel
Value of Hull
Horsepower
Maximum speed  (MPH)

BOAT TRAILER
Year:
Make
Model
Serial Number
Value of Trailer

 

 

MOORING

List mooring location in season and off season (provide address of mooring location)
IN Season
Address:  
County:
City:  
State:  
Zip Code:  
OFF Season
Address:  
County:
City:  
State:  
Zip Code:  

 

Waters Navigated
Inland Lakes and Streams Yes     No
Tidal/Coastal Waters Yes     No
Both Yes     No

 

Liability Coverage
Bodily Injury
Property Damage

 

Uninsured Motorists
Uninsured Motorists
Underinsured Motorists

 

Underwriting Information
Do you have Homeowners Insurance? Yes     No

 

Comments

 

 Be patient, it will take some time for the information to be processed.  A Form Confirmation will be displayed.  Please review the information you entered.  If you need to correct any information, use the "Back" arrow on your browser to return to the form with the data you entered still in the form.  Clicking on "Return to the Form" will erase all data and return you to an empty form.

Are you ready to send this information? (type "YES")           

                             A quote will be returned to you within one business day.

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Revised: August 06, 2010