Forms :: Boater's Choice Insurance ::

Sea_Ray_Owners_Club_Member_Quick_Quote

Fields marked with * are required.

Boat Owner Information
First Name:
Middle Initial:
* Last Name (or company):
* Telephone (Home):
* Telephone (Work):
Telephone (cell):
Fax:
* Address:
* City:
* State:
* Zip Code:
Dwelling:
* Date of Birth:
Marital Status:
* SSN:
* E-mail Address:
* Is this the first boat owned?:
* Years of Boat Ownership:
* Length of Most Recent Boat And For How Long? :
* Claims/Accidents on Any Boat?:
If Yes, please explain (including dates and amounts paid)::
Current Insurance Company:
Current Premium:
Expiration Date of Current Policy:
Sea Ray Vessel Details
* Sea Ray Model:
* Year:
* Length:
Hull ID Number:
* Date of Purchase:
* Purchase Price:
* Previously Untitled?:
* Navigation Area:
* Nav. Limit:
* Type of Boat:
* Usage:
If Business or Commercial, please explain:
Main Engine Information
* Engine Type:
* Fuel Type:
* Manufacturer:
* Number of Engines:
* Maximum Horsepower (per engine):
* Maximum Speed (mph):
Mooring Location
* Mooring Address:
* Mooring City:
* Mooring County:
* Mooring State:
* Mooring Zip:
Insurance Coverage Requested
* Hull & Machinery Value:
Trailer Value:
Dinghy/Tender Value:
* Liability Limit:
Deductible:
* Personal Effects:
Will Vessel Need A Lay Up? :
Type of Lay Up:
Length of Lay Up (Months):
* Towing:
* Has any boat insurance policy been cancelled or non-renewed in the past 5 years?:
If so, please provide details:
* How did you hear about us?:
Leinholder Information (including address):
Notes to Underwriter:
Dealer Information (if applicable)1
Dealership Name:
Dealership Address:
Dealership City, State Zip:
Dealership Phone # (XXX-XXX-XXXX):