Quotes

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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!

Full Name

Address

Phone Number

Email Address

Boat Type
speed boatfishing boatpontoon boatother

Other boat type:

Hull Type
fiberglassaluminumother

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?
yesno

Name of financial institution:

Do you want to insure the boat against physical damage?
yesno-just liability to others

Comprehensive deductible:

Collision deductible:

On-Water Towing?
yesno

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

Trailer Year

Boat Storage Zip Code

Remarks (if any)

Applicant’s Gender
malefemale

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.

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Do you have motorcycle endorsement on license?
yesno

Medical Payments (for you and passengers)

Physical Damage to Motorcycle
Comprehensive

Collision

Roadside/Trip Interruption?
yesno

Modified frame, nitro oxide, turbo or supercharger?
yesno

Anti-lock brakes?
yesno

Lo-jack device installed?
yesno

How many years of riding experience do you have?

Have you completed an approved safety course?
yesno

How often do you ride during season?

How much accessory coverage do you need?
(base policy generally covers up to $3,000)

Remarks (if any):

Full Name

Address

Phone Number

Email Address

Travel Trailer Year

Travel Trailer Make

Travel Trailer Model

Travel Trailer VIN (17 characters)

Body Style (length & number of slides)

How is travel trailer towed?
bumper hitchbed hitch

Date of purchase

Are you the original owner?
noyes

Current value of travel trailer

Garaging Zip Code

Is travel trailer parked at a single location year round?
noyes

Is the travel trailer a rented vehicle, ever rented to others, or used for business?
noyes

Is the travel trailer taken to/from work or used at a work location?
noyes

Primary vehicle use
recreationprimary residence

What is the approximate number of days used per year?

Is the travel trailer financed?
noyes

Name of financial institution

Years of experience operating a travel trailer (in years. Enter 0 if none)

Liability coverage is extended from the towing vehicle.
Are you interested in covering the travel trailer against physical damage?
noyes

Comprehensive Deductible (Actual Cash Value – ACV)

Collision Deductible (Actual Cash Value – ACV)

Additional vacation liability (includes $10,000)
noyes

Personal Effects (round to nearest thousand dollars. Enter ‘0’ if none)

Roadside Coverage
noyes

Remarks (if any)