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Driver Name
*
First
Last
Date of Birth
*
Month
Day
Year
License State
*
Select One
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
License #
*
VIN
Vehicle Identification Number
I don't have the VIN
Confirm VIN
Year
*
Make
*
Model
*
Hidden
Vehicle Type
Hidden
Gross Vehicle Weight
Vehicle Coverage
*
Liability Only
Comprehensive Only
Full Coverage
Liability Only
includes coverage only for damage you cause to other peoples property, not for your vehicle.
Comprehensive Coverage
protects you against anything other than Collision, such as theft or storm damage.
Full Coverage
includes Liability, Comprehensive and Collision Coverage.
Comprehensive Deductible
*
Select a Deductible
$0
$100
$250
$500
$1,000
Collision Deductible
*
Select a Deductible
$0
$100
$250
$500
$1,000
Other Coverage
Towing
Extended Transportation (rental reimbursement)
Vehicle Replacement Coverage (New vehicles only)
Use Type
*
Select
Business Use
Commute
Pleasure Only
Maximum Annual Mileage
*
Select
0 - 5,000
500,1 - 10,000
10,001 - 15,000
15,001 - 20,000
20,001 - 30,000
30,000 or more
Driver Name
*
First
Last
Date of Birth
*
Month
Day
Year
License State
*
Select One
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
License #
*
Year
*
Make
*
Model
*
Type of Watercraft
*
Bass Boat
Bay Boat
Bowrider
Cabin Cruiser
Center Console
Deck Boat
Dinghy
High Performance Boat
Jet Boat
Jet Ski (Personal Watercraft)
Pontoon Boat
Power Catamaran
Sail Boat
Ski & Wakeboard Boat
Length of Watercraft
*
Where is this watercraft primarily used?
*
Inland Lakes and Rivers
Coastal Waters
How many motors does the watercraft have?
*
1
2
3
4
Max HP
*
Max Speed
*
Trailer?
*
Yes
No
Value of Trailer
*
Value of Watercraft (not including trailer)
*
Motor Details
*
I can provide them now
I'll provide them later
Motor 1- Type
*
Inboard
Outboard
In/Outboard
Trolling Motor
Horsepower
*
Motor 2 - Type
*
Inboard
Outboard
In/Outboard
Trolling Motor
Horsepower
*
Motor 3 - Type
*
Inboard
Outboard
In/Outboard
Trolling Motor
Horsepower
*
Motor 4 - Type
*
Inboard
Outboard
In/Outboard
Trolling Motor
Horsepower
*
Deductible
*
Choose your Comprehensive Deductible
I do not want Comprehensive Coverage
$0
$50
$100
$250
$500
$1,000
Personal Effects (if any)
Value for Skis, Vests, Floats, etc. stored on the watercraft