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  
Manufacturers Name 
Year 
 
Model 
 
Length 
   
How long have you owned this vessel 
   
** If vessel exceeds 10 years of age, salt water use, and over $75,000. a recent Condition and Value Survey will be needed. 
Type of Boat
 
Fuel Type
 
Engine Type
 
Total Engine Horsepower
 
Value of Watercraft & Motor (s)
 
Trailer Information    
Trailers Manufacturers Name 
 
Trailers Year 
 
Value of Trailer
 
Usage Information    
Primary Waters Navigated 
 
Is your watercraft 
 
Where is it moored, docked or trailered? (City & State) 
Winter Lay Up Location 
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!