MARINE INSURANCE QUOTE REQUEST
Please answer all the following questions
or CALL ME RIGHT NOW! at 413-923-1737
Watercraft Owners Information
Owners Name
Address
My Email
Best Phone Number
City
Zip
State
Number of years boating
# of years as a watercraft owner
Watercraft Information ***If your vessel is over 28 ft and over 10 years of age, a current Condition and Value Survey will be needed to provide a quote ***
Manufacturers Name
Year
Model
Length
How long have you owned this vessel
Type of Boat
Power Boat
Sail Boat
Fuel Type
Gas
Diesel
Engine Type
Inboard
Outboard
Inboard/Outdrive
Jet
Twin Engine
Total Engine Horsepower
Value of Watercraft & Motor (s)
Trailer Information
Trailers Manufacturers Name
Trailers Year
Value of Trailer
Usage Information
Primary Waters Navigated
Inland
Coastal
Is your watercraft
Trailered
Moored
Docked
Where is it moored, docked or trailered? (City & State)
Winter Lay Up Location
Please Select
Residence
Marina
Hauled
Afloat
Safety Information
Fume Detector
yes
no
Licensed Captain
yes
no
Depth Finder
yes
no
Boat Radar
yes
no
GPS
yes
no
Auto C02 Halon Fire Extinquisher
yes
no
VHF Radio
yes
no
Coast Guard Pwr. Squadron Course
yes
no
Operator Information
Operator #1------------------------------------------------------------------------------------------
Name
Date of Birth
Drivers License Number
Drivers License State
Operator #2--------------------------------------------------------------------------------------------
Name
Date of Birth
Drivers License Number
Drivers License State
Operator #3--------------------------------------------------------------------------------------------
Name
Date of Birth
Drivers License Number
Drivers License State
Past Boating Claim Infomation
Had previous boating claims?
yes
no
If yes, please describe
Thank you for contacting Finck and Perras Marine Insurance!