Year
Manufacturer
Model
Watercraft Type
Runabout
Bass Boat
Cabin Cruiser
Pontoon
Sailboat - Single-Hull
Sailboat - Multi-Hull
Houseboat
Inflatable
Length
Boat Use?
Pleasure Use
Racing/Speed Contests
Business/Commercial Use
Rented or Leased to Others
Residence
Market Value
Number of Engines
0
1
2
3
4+
Total Horsepower
Engine Type
Outboard
Inboard
Stern Drive (I/O)
Waterjet Pump
Other
Deductible
$500
$1000
Other
No Coverage
Hull Material
Fiberglass
Aluminum
Rigid Hull Inflatable
Inflatable
Roplene
Wood
Steel
Trailer Coverage
Not Desired
$1,000
$2,000
$3,000
$4,000
$5,000
$7,500
$10,000+
Storage Location
Home
Marina
Storage Facility
Does your boat or engine have any structural modifications or performance customization?
Yes
No
Year (B2)
Manuf. (B2)
Model (B2)
Watercraft Type (B2)
Runabout
Bass Boat
Cabin Cruiser
Pontoon
Sailboat - Single-Hull
Sailboat - Multi-Hull
Houseboat
Inflatable
Length (B2)
Boat Use? (B2)
Pleasure Use Exclusively
Racing/Speed Contests
Business/Commercial Use
Rented or Leased to Others
Residence
Market Value (B2)
Number of Engines (B2)
0
1
2
New Option
3
4+
Total Horsepower (B2)
Engine Type (B2)
Outboard
Inboard
Stern Drive (I/O)
Waterjet Pump
Other
Deductible (B2)
$100
$250
$500
$1000
No Coverage
Hull Material (B2)
Fiberglass
Aluminum
Rigid Hull Inflatable
Inflatable
Roplene
Wood
Steel
Trailer Coverage (B2)
Not Desired
$1,000
$2,000
$3,000
$4,000
$5,000
$7,500
$10,000+
Storage Location (B2)
Home
Marina
Storage Facility
Primary Operator Name
Gender
Option 1
Option 2
Option 3
Married?
Option 1
Option 2
Option 3
Date of Birth
Accidents/Tickets in the past 3 years
0
1
2
3
4+
Operator 2 Name (if necessary)
Gender (O2)
Option 1
Option 2
Option 3
Married? (O2)
Option 1
Option 2
Option 3
Date of Birth (O2)
Accidents/Tickets in the past 3 years? (O2)
0
1
2
3
4+
First Name
Last Name
Line 1
Line 2
City
State
Zip Code
Country
