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Watercraft
Quote Form |
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Please
provide the following information as accurate as possible.
Information provided will not be used for anything other than for the
purpose of this form. |
| Name: |
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| Street
address: |
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| City: |
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| State: |
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| Zip: |
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| Phone: |
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| E-Mail: |
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| Date
of birth: |
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Have
you had a bankruptcy
tax lien, judgment,
foreclosure, or repossession
in the last three years?: |
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County
in which the
watercraft is principally
kept: |
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Do
you currently have
insurance on your
watercraft?: |
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| If
yes, with which company?: |
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| Type
of watercraft: |
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| Year
Built: |
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| Make: |
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| Model: |
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| Length: |
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| Current
value: |
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Does
the value include
a trailer?: |
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| Total
horsepower: |
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| Number
of motors: |
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| Type
of propulsion: |
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| Hull
material: |
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Is
your watercraft modified
for enhanced performance?: |
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How
do you use your
watercraft?: |
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Does
anyone else besides
you (and/or your spouse)
share ownership in the
watercraft?: |
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What
limits of liability
coverage do you want?: |
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Do
you want uninsured/
underinsured boater
coverage?: |
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Do
you want medical
payments coverage?: |
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Do
you want coverage
for personal items on
your watercraft? (Such as
water-skis, lifejackets,
depth finders, GPS
equipment, coolers,
radios, cell phones): |
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Do
you want coverage
for fishing equipment?: |
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What
deductible do you
want on comprehensive
coverage?: |
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What
deductible do you
want on collision coverage?:
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| Driver
#1 info: |
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| Age: |
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| Sex: |
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| Marital
status: |
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Do
you have any accidents,
violations, or tickets in the
last three years?: |
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If
yes, list infractions,
and dates they occurred: |
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| Driver
#2 info: |
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| Age: |
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| Sex: |
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| Marital
status: |
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Do
you have any accidents,
violations, or tickets in the
last three years?: |
|
If
yes, list infractions,
and dates they occurred: |
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How
did you hear about
Budget Insurance
Offices, Inc.?: |
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