Fields with * are mandatory, please fill in as much information as possible:
Date of Birth
Primary # *
Driver's license number
Hull Material (Roplene, carbon fiber, and rotomolded technologies should be classified as Fiberglass)
Number of Motors(do not include trolling motors)
Total Horsepower (If more than one motor, add the horsepower of all motors to determine total. Do not include kicker or trolling motors.)
Primary Use (Pleasure use exclusively/Racing Speed Contests/Business Commercial/Rented or Leased to Others/Primary Residence)
Watercraft Zip Location (where watercraft is located for majority of year)
Own or lease?
What year was this watercraft acquired?
Market Value of Watercraft(enter whole dollars only) (include all motors and add value of trailer if coverage is requested)
Moved in the last 2 months?
Years Boating Experience
Accidents, Violations, and Claims
As a driver in the last 3 years, have you had any of the following regardless of fault (including automobile):
e.g.: hitting a car/object/property/animal, car hits you, weather, vandalism, theft, hail
Tell us about your insurance...