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Are you over-paying for insurance?

Take 3-5 minutes and fill out this form. It doesn’t cost you anything and it doesn’t show as a hit against your credit!

It’s not uncommon for us to be able to save customers hundreds of dollars per year!

Boat Type
speed boatfishing boatpontoon boatother

Hull Type

Boat Year

Length of Boat

Motor Year

Coverage Options (Liability to Others)
Bodily Injury(per person) / Bodily Injury (per accident) / Property Damage (per accident)

Medical Payments (for you and passengers)

Physical Damage to Boat
Comprehensive:______ Collision:______

On-Water Towing?

Do you want to insure a trailer?

Trailer Year

Boat Storage Zip Code

Remarks (if any)

Applicant’s Gender

Type of Life Insurance
term lifewhole life

Select Term Length

Amount of Insurance Requested

Applicant’s Height

Applicant’s Weight

List any medical conditions, family history, or medications currently taken.


Do you have motorcycle endorsement on license?

Medical Payments (for you and passengers)

Physical Damage to Motorcycle
Comprehensive:______ Collision:_______

Roadside/Trip Interruption?

Remarks (if any):