Boat Quote - Steve Heald Insurance Agency

WATERCRAFT OWNERS QUOTE REQUEST

PLEASE provide us these SIMPLE answers below, then we can get a new quote started right away!
(Your infomation will always kept secure and confidential and only be used for this quote request. This information will NOT be shared!)

Basic Watercraft Owners Information

Owner's Full Name*

Number of Additional OWNERS (excluding you, your spouse and/or relatives)

Is this vessel owned under corporate ownership for tax purposes?

Yes

Street Address

City/Town

State

Zip Code

Contact Phone #*

Best Time to Contact

Email*

How Many YEARS of Experience do you Have OWNING A BOAT?

Have you maintained watercraft insurance for past 12 months (with no lapse)?

Yes

Do you currently have 1 (or more) policies with Farmers, Foremost or Zurich?

Yes

Have you had ANY Marine Related Accidents or CLAIMS in the past 36 months?

Yes

If YES, Please Describe Damage and the Amount Paid on Claim (Estimate)

Who is Your Current Insurance Company?

NONE

When is the Expiration Date of Your Current Policy?

How Did You Find Us? (or Referred By Whom...?)

Referral Source:

Mooring Information (Place of Storage)

Do you store this vessel at address listed above (when not used)?

Yes

If not at home, Is it kept in the water at a marina?

Yes

If not at home, Is it secured or protected in anyway?

Yes

If not at home, what it the mooring Zip Code?

Please List PRIMARY Drivers ONLY (Name and DOB)

Driver Number 1:

Date of Birth

Driver Number 2:

Date of Birth

Driver Number 3:

Date of Birth

Driver Number 4:

Date of Birth

Please indicate and Completed Boat Safety/Navigation Course(s) taken by owner(s) or Owner Operator?

Coast Guard Auxiliary

Captain's License

Marine Pilot's License

Merchant Marine License

Coast Guard Course

Chapman Boating School

Power Squadron Course

State/Fed Accredited Maritime Academy

Commercial Aviation License

COVERAGE AND LIMITS of Watercraft:

Personal Liability Coverage Limits
(Bodily Injury and Property Damage - Combined Single Limit)

Medical Payments

Uninsured Watercraft Coverage (for B/I passenger damages in your vessel)

Watercraft's Insurance Coverage (HULL VALUE - Includes Inboard Engine)

Outboard Engine Coverage (ENGINE VALUE)

Claims Settlement Valuation Method (Agreed value is better)

Trailer Coverage (TRAILER VALUE)

Trolling Motor Value (if applicable)

Personal Property Coverage (if desired)

Personal Property Replacement Cost (optional)

Yes

Towing and Assistance Coverage (optional)

Policy Deductible Per Claim

Other Personal Lines Policies You may be Interested?

Personal Auto

Primary Homeowners

Non-Owner Occupied Homeowners

Renters Insurance

Life Insurance

Recreational Vehicles (Boats, RV's, etc.)

Any Additional Comments and/or Requests:

* = Required Field

- THANK YOU -

We Really Appreciate Your Business!!!

Steve will personally be in contact with you shortly.

OR..... If you would prefer, feel free to CALL US
TOLL FREE: (888) 432-5301