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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

Other boat type:

Hull Type

Hull ID No.

Registration No. (if already registered)
(begins with “IN####XX”)

Date of purchase

Boat Year

Length of Boat ft’

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)

Did you finance this purchase?

Do you want to insure the boat against physical damage?

Comprehensive deductible:

Collision deductible:

On-Water Towing?

Do you want to insure the trailer against physical damage?
(deductibles selected on boat will also apply to 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):