Online Boat & Jet Ski Insurance Quote Form One Simple Form - takes only 2-3 Minutes! Your Personal Data
Your Name
Street Address
City
State	MUST be New Jersey!
Zip Code
E-Mail (REQUIRED)
E-Mail again for accuracy
Phone
Fax (optional)
Marital Status Single Married	Homeowner? Yes No
Boat Currently Insured? (If yes, list carrier, and # of years continuous. If none, type N/C)
Is this Boat Co-owned? (If yes, list all owners names)

OPERATOR INFORMATION #1
Name		Birth date
Sex (M/F)		# Years U.S.  Licensing
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:
Number & Type of Accidents last 3 years		Number & Type of MINOR violations last 3 years
Number & Type of MAJOR violations last 3 years		Number of Years Boating Experience

OPERATOR INFORMATION #2 (if none, leave blank)
Name		Birth date
Sex		# Years U.S.  Licensing
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations in fields below:
Number & Type of Accidents last 3 years		Number & Type of MINOR violations last 3 years
Number & Type of MAJOR violations last 3 years		Number of Years Boating Experience

VESSEL & UNDERWRITING INFORMATION
Year of Boat		Make & Model (be specific)
Boat Length		Hull Type (wood, Metal, fiberglass, etc):
Max. Speed (in MPH)		Market Value: $
Engine Make		Engine Type (Inboard, I/O, Jet)
Engine Horse Power		Fuel Type (Gas, Diesel, etc.)
Trailer Cov. Needed?	Yes No	Yr./Make/Model of Trailer
Trailer Value: $		Where is boat moored or stored?
Describe waters boat taken on?		Describe boat general usage? (fishing, ski, etc.)
VESSEL COVERAGES
Limits of Liability	$15/30 BI / 10 PD    $25/50 BI / 15 PD $50/100 BI / 25 PD   $100/300 BI / 50 PD $250/500 BI / 100 PD
Hull Coverage	NO Coverage      $250 Deductible $500 Deductible $1000 Deductible
Water Ski Medical Coverage?	Yes No	Uninsured   Motorists Cov.?	Yes No

Comments or Remarks: (List additional drivers, special coverages, etc. here)
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