Please fill out the form below with the information we require in order to provide you with a quote.
Once completed the information will be submitted. If you should have any questions please email
info@boat-ins.com
with any and all questions.
Please complete
all
areas - Required area marked with (
*
) - Thank You.
Name
*
:
DOB:
Address
*
:
City/Zip
*
:
State
*
:
Phone:
Social Security:
E-mail:
Do you give permission for an insurance company to check your credit score?
*
Boating claim information:
Claim Details:(If none, skip details)
Claims
*
:
None
One
Two
Three
Multiple
Dates:
Enter dates. Seperate with : or /
Details:
Enter descriptions. Seperate with : or /
Amounts:
Enter amounts. Seperate with : or /
Boating Background:
Years Experience
*
:
Courses:
Years Owner:
Prior Vessels
*
:
Please include year and make. Seperate each with - or /
Boat looking to Insure:
Year
*
:
Model:
Manufacturer
*
:
Length
*
:
Engine:
Year
*
:
Type
*
:
Horsepower
*
:
Fuel
*
:
Manufacturer
*
:
Other Details:
Mast Material
(Sailboat)
Equipment:
VHF
FUME DET
GPS
CO2
RADAR
To select Multiple items, hold control button and click with mouse.
Trailer:
Year:
Manufacturer:
Value:
Serial #:
Dinghy:
Year:
Length:
Maufacturer:
Value:
Serial #:
Dinghy O/B:
Year:
HP:
Manufacturer:
Value:
Serial #:
Operation Details:
Where will the vessel be navigated:
Lay-up Period
*
:
Mooring/Storage Location:
Summer
*
:
Winter
*
:
Is Vessel stored at apt. or condo on trailer?
Ownership Details:
Date of Purchase
*
:
Survey Info:
Yes
No
Purchase Price
*
:
x
Date:
Additional Investment$:
Surveyor:
Loss Payee:
Bank:
Address:
Please make sure all the information above is accurate and complete. Once the submit button is pressed, it will be sent to Alan R. Mott Agency, INC. YOU WILL ALSO RECEIVE A COPY OF THE INFORMATION, IF YOU PROVED AN EMAIL ADDRESS. Please submit any and all questions to
info@boat-ins.com
and a representative will contact you.
Thank you.