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Watercraft Quick Quote Form
Producer Name: Producer Code:
Phone #: Fax #:
Producer Email:
Owner Information
Date of Birth: SS# (Optional): Mailing Zip Code:
Mailing Address: City:
Marital Status:  Do you own your own home: 
Boat Information
In Season Location Zip Code: Address: City:
Manufacturer: Year: Model: Current Value:
Hull Type: Hull Material: Propulsion:
Length: Speed: Weight: Number of Engines:
Total Horsepower: Fuel Type: Purchase Price: Purchase Date:
Navigation Teritory:
Lay-up: Dates  From: To:
Safety Equipment (check all that apply):      
Operator Information
Is the Owner the Primary Operator? Married Homeowner
# of years Boating Experience (Provide full description of all boats owned including length and speed):
Motor Vehicle Violations/Accidents:
Provide All Marine Losses:
Coverages & Limits
Watercraft Coverage: $(boat & engines) Deductible:
Settlement Type:
Liability Coverage: Med Pay: $1,000 Included (Higher Limits available)
Personal Effects: $1,000 Included (Higher Limits available) Pollution:
Trailer: $ Towing: $750 Included (Higher Limits available) Boat Lift:
Boat House:

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