Watercraft Owner Information
Last Name
First
Address
City
State
New York
Zip Code
Phone
Fax (optional)
You may contact me at the above number to
discuss this quote
E-Mail (Required)
Marital Status
Currently Insured
Social Security #
Driver's License #
Years Boating Experience
New Purchase
If new purchase, expected delivery date
Claims On Watercraft
Violations On Driver License
Claims & Violations and
Watercraft Information
Type of Watercraft
Choose One
1 Seated
1 Upright
2 Seated
3 Seated
4 Seated
Year of Watercraft
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
We do not insure watercraft older than 20 years
Manufacturer
Model
Current Value $
(in thousands)
CC Size
Watercraft Damage Deductible
Choose One
No Coverage
250
500
1000
Current Value of Trailer $
Trailer Damage Deductible
Choose One
No Coverage
100
Personal Liability
Choose One
10,000/20,000/10,000
15,000/30,000/10,000
20,000/40,000/20,000
25,000/50,000/25,000
30,000/60,000/30,000
50,000/100,000/50,000
100,000/300,000/100,000
250,000/500,000/250,000
Medical Payments:
Choose One
None
1,000
2,500
5,000
10,000
Water-Skiing & Towing Sports Liability
(must match personal liability limits)
Uninsured Watercraft Liability
(must match personal liability limits)
Towing & Assistance
Accessories
Value $
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If by Phone, best time to call
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