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Yacht Quick Quote Form
Producer Name: Producer Code:
City:
Phone #: Fax #:
Producer Email:
Owner Information
Name: Ownership:
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? Liveaboard
# of years Boating Experience (list previously owned boats -include length and # of years operated):
Provide All Marine Losses:
Coverages & Limits
Hull Coverage: $(boat & engines) Deductible:
Settlement Type: Uninsured: Included (w/ P&I)
P&I Coverage: Med Pay: $10,000 Included (Higher Limits available) P&I Only:
Personal Effects: $2,500 Included (Higher Limits available) Fishing Equipment:
Trailer: $ Towing: $750 Included (Higher Limits available) Boat Lift:
Boat House: Tender: (Coverage provided at limit shown with ACV settlement & a $500 deductible.)
Paid Crew: (Enter #)
 


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