Free E-Mail Quote
Available only to residents of Texas.

Personal Information

Name
Zip Code
(Optional) Phone Number
(Optional) Fax Number
E-mail
Do you have insurance now?	Yes    No   (Discount)

Driver Information

	Age	Gender	Marital Status	Years Licensed	Boating Association Member?	Years Experience
Boater #1		M F	Married Single	1-2 yrs 2-3 yrs > 3 yrs">3 yrs">> 3 yrs	No Yes
Boater #2		n/a M F	n/a Married Single	n/a 1-2 yrs 2-3 yrs > 3 yrs">3 yrs">> 3 yrs	n/a Yes No

Watercraft Information

Year Built	Length (Feet)	Name of Craft
Make		Model
Hull ID Number		Hull Type
Hull Material

Engine Information

# of Engines  1 2 3 4	Type  Gas Diesel Inboard Outdrive/I/O Outboard Jet Drive	Year Built	Horsepower
Engine Serial Numbers

Trailer Information:

Year

Length

Manufacturer

Serial #

Tender Information 

Year

Length

Manufacturer

Serial #

Tender's Motor 

Year

HP

Mfg

Serial #

Equipment Information

Loran No Yes	Radar No Yes	Halon No Yes
GPS    No Yes	Depth Finder No Yes	VHF No Yes

 Navigation

Area where vessel will be used

Inland Coastal Ocean

Area where vessel will be laid up

Ashore Afloat

Where

 

Chartered

No Yes

Ever used for water skiing?

Yes No

If watercraft is in excess of 24 feet, is it ever transported over land?

Yes No

 Coverage Desired

Effective Period From

to

	Values	Deductible
Hull and Machinery
Outboard Motor
Equipment
Tender and its Motor
Trailer
Liability
Medical Payments
Overland Transp. (miles)
Uninsured Boaters
Personal Effects
Assistance/Towing

Information is provided for the purposes of quoting only. Accuracy of the quote depends on information provided. Coverage is not bound by completion of this form. A credit check may be obtained to determine rates.