BOAT INSURANCE QUOTE Requesting a Boat Insurance Quote is fast and easy, and if you like the quote, we can bind coverage online. If you need any help please call 361-756-5020 or text 361-219-8751. QUOTE EFFECTIVE DATE: ? If you like the quote, when do you want coverage to start? This is usually either "today's date" or your existing insurance "due date" or your current "policy term expiration date". CONTACT INFORMATION: ? Please provide your information, even though you might not live with the person(s) you are requesting the quote. If you are the Main Policyholder or a driver in this quote, still put your name here as it appears in you DL or ID and you can type "same as above" in the DRIVER SECTION: Your Name: Your Phone: Your Email: DRIVER SECTION: (Please for the most accurate Quote, list all drivers.) FIRST DRIVER-MAIN POLICYHOLDER: ? This is the only Driver that cannot be exclude from the policy. The Policyholder or the Main Insured is the one that is allowed to make changes on the policy. The main Policyholder can add a second Policyholder, this usually is the spouse, however it can be any of the other Household Member drivers. FIRST MI LAST: POLICYHOLER'S PHYSICAL ADDRESS: ? This is also know as the garaging address. Where the vehicles will be parked. If Policyholder has a different mailing address, this will be given later. CITY / STATE / ZIP: Date Of Birth(DOB): Driver's License # or State ID #: Occupation: Marital Status: CHOOSE ONESINGLEMARRIEDSEPERATEDDEVORCEWIDOW(ER) Do you need add another Household Member? YESNO 2nd Household Member: First MI Last: Check if you want to Exclude as Driver: Excluded Driver Date Of Birth(DOB): Marital Status: CHOOSE ONESINGLEMARRIEDSEPERATEDDEVORCEWIDOW(ER) Driver's License # or State ID #: Occupation: Relationship to MAIN POLICYHOLDER: SpouseChildParentGrand-ParentGrand-ChildRelativeFriendOther Do you need to add another household member? YESNO 3rd Household Member: First MI Last: Check if you want to Exclude as Driver: Excluded Driver Date Of Birth(DOB): Marital Status: CHOOSE ONESINGLEMARRIEDSEPERATEDWIDOW(ER) Driver's License # or State ID #: Occupation: Relationship to MAIN POLICYHOLDER: SpouseChildParentGrand-ParentGrand-ChildRelativeFriendOther Do you need to add another household member? YESNO 4th Household Member: First MI Last: Check if you want to Exclude as Driver: Excluded Driver Date Of Birth(DOB): Marital Status: CHOOSE ONESINGLEMARRIEDSEPERATEDDEVORCEWIDOW(ER) Driver's License # or State ID #: Occupation: Relationship to MAIN POLICYHOLDER: SpouseChildParentGrand-ParentGrand-ChildRelativeFriendOther Do you need to add another household member? YESNO 5th Household Member: First MI Last: Check if you want to Exclude as Driver: Excluded Driver Date Of Birth(DOB): Marital Status: CHOOSE ONESINGLEMARRIEDSEPERATEDDEVORCEWIDOW(ER) Driver's License # or State ID #: Occupation: Relationship to MAIN POLICYHOLDER: SpouseChildParentGrand-ParentGrand-ChildRelativeFriendOther Do you need to add another household member? YESNO Additional Driver(s): WATERCRAFT/BOAT SECTION: (LIST ONLY THE WATERCRAFT/BOAT(S) YOU WANT INSURANCE) WATERCRAFT/BAOT #1 WATERCRAFT/BOAT Identification Number(VIN): Year / Make / Model: Liability Limits for the Policy on each WATERCRAFT/BOAT. YESNOOTHER Uninsured Boaters and Underinsured Boaters: (SELECTION APPLIES TO ALL WATERCRAFT/BOAT IN THE POLICY) NoneYESNO Medical Payments Coverage: (SELECTION APPLIES TO ALL WATERCRAFT/BOAT IN THE POLICY) NoneYESNO COMPREHENSIVE/COLLISION COVERAGE: NoneYESNO Personal Property Coverage: NoneYESNO Do you need to add another WATERCRAFT/BOAT? YESNO WATERCRAFT/BAOT #2 Vehicle Identification Number(VIN): Year / Make / Model: Liability Limits (Already Selected) LIABILITY ONLY-SKIP DOWN TO NEXT "WATERCRAFT/BOAT" IF COMPLETED WITH WATERCRAFT/BOAT SKIP DOWN TO "DISCOUNT SECTION:" VEHICLE#2 COMPREHENSIVE/COLLISION COVERAGE: NoneYESNO Do you need to add another WATERCRAFT/BOAT? YESNO WATERCRAFT/BAOT #3 WATERCRAFT/BOAT Identification Number(VIN): Year / Make / Model: Liability Limits(Already Selected) LIABILITY ONLY-SKIP DOWN TO NEXT "WATERCRAFT/BOAT" IF COMPLETED WITH WATERCRAFT/BOAT SKIP DOWN TO "DISCOUNT SECTION:" WATERCRAFT/BOAT#3 COMPREHENSIVE/COLLISION COVERAGE: NoneYESNO Do you need to add another WATERCRAFT/BOAT? YESNO WATERCRAFT/BAOT #4 Vehicle Identification Number(VIN): Year / Make / Model: Liability Limits(Already Selected) LIABILITY ONLY-SKIP DOWN TO NEXT "WATERCRAFT/BOAT" IF COMPLETED WITH WATERCRAFT/BOAT SKIP DOWN TO "DISCOUNT SECTION:" COMPREHENSIVE/COLLISION COVERAGE: NoneYESNO Do you need to add another WATERCRAFT/BOAT? YESNO ADDITIONAL WATERCRAFT(s) Your almost done. DISCOUNT SECTION: ? We cannot just give you discounts, you need to qualify for them, however a good Agent will try his best to ask you question to determined which apply to you. Some discounts are automatic and other need to be applied. One of the main discounts deal with rewarding safe drivers, which major Insurance Carriers accomplish this with Telematics, either with a device installed under your dashboard or an app install on your mobile device. Discounts add up to big savings, please do not be shy to ask if you qualify for them. We will do our best to apply the most discounts possible. (Select all that applicable) Prior/Existing InsuranceMulti-PolicyPaperlessAUTO PAYPay In FullSafety Course