Watercraft Quote - Midwest Certified Insurance Agency

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Watercraft QuoteAdrian2017-01-31T13:51:34-06:00

Downloadable Form

Watercraft Quote Worksheet

Watercraft Online Quote Form

Step 1 of 6

16%

Operator Information
Number of children under the age of 18 living in the household*
Insured's Name*
First Last
Email*
Enter Email Confirm Email
Gender*
- Male
- Female
DOB*
Driver's License Number*
State the license is issued in*
Marital Status*
Years of Boating Experience*
Safety Course*
- State
- Power Squadron / Coast Guard
- None
Has operator 1 had any Tickets or Accidents in the last 5 years?*
- Yes
- No
Violation*
Date of Violation*
Month
Day
Year
Add another Ticket or Accident*
- Yes
- No
Violation*
Date of Violation*
Month
Day
Year
Add another Operator*
- Yes
- No
Operator 2 Information
Name*
First Last
Gender*
- Male
- Female
Date of Birth*
Month
Day
Year
Driver's License Number*
State the license is issued in*
Martial Status*
Years of Boating Experience*
Safety Course*
- State
- Power Squadron / Coast Guard
- None
Has Operator 2 had any Tickets or Accidents in the last 5 years?*
- Yes
- No
Violation*
Date of Violation*
Month
Day
Year
Add another Ticket or Accident*
- Yes
- No
Violation*
Date of Violation*
Month
Day
Year

Mooring Information
Mooring Type*
- Private Residence
- Marina
- Yacht Club
- Boat Storage Facility
- Other
Mooring/Garaging Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Watercraft Information 1/2
Year*

xxxx
Make*
Model*
Length*
Horsepower*
Current Value*
Hull ID Number*
Watercraft Information 2/2
Watercraft Style*
- Bass Boat
- Canoe/Kayak
- Cruiser
- Jet Boat
- Other Fishing
- Personal Watercraft
- Pontoon
- Runabout
- Sailboat
Propulsion Style*
- Outboard
- In/Out
- Inboard
- None
Is the engine exposed?*
- Yes
- No
Construction*
- Fiberglass
- Metal
- Wood

Motor Information
(Outboard motors should be listed separately from hull value. All other motors, including trolling and other auxillary motors should be included in the hull value)
Year*
Make*
Horsepower*
Motor ID Number*
Value*

Trailer Information
Year*
Make*
Value*
Trailer ID Number*

Coverage Information
Liability*
UWBI*
Medical Pay*
Hull Deductible*
Trailer Deductible*
Outboard Motor Deductible*
Additional Fishing Equipment*
Increased Coverage for Unattached Equipment*
- Yes
- No
(unattached equipment includes but is not limited to: Anchors, oars, lights, fire extinguishers, tarpaulins, safety and lifesaving equipment, portable marine electronics, deck chairs, water skis, wake boards and similar sports equipment).

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