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Personal Watercraft (Jet ski)/Trailer Quote Form
Boat Owner's Name
Driver's Date of Birth
Driver's License #
Driver's Mailing Address
Home Phone #
Work Phone #
Cell Phone #
Best # to Call and Time
Email address
Watercraft Year, Make and Model
Unit Type
Personal Watercraft Deductibles
Engine Displacement (Total cubic cm)
Trailer Year, Make, Model and vin #
Maximum Speed
Original Owner
yes
no
Multi-owner
yes
no
Violations
Prior Watercraft Insurer and Expiration Date
Boat Location
Rack Storage
At Dock
On Trailer
On Mooring *
Accessories (round to nearest $100)
Property Damage Liability Limit
Boldily Injury Liability Limit
Medical Payment Limits
Uninsured Watercraft Liability Limits
Watersports Liability - Bodily Injury
Watersports Liability-Property Damage
Other Information (additional drivers, mooring, etc.)
Boating Safety Course
yes
no
Boating Experience
Summer, Winter, Spring Storage
Boating Clubs
Date of Inquiry