Insurance Products

Yacht Insurance Quote

Enter and submit the information below and a U.S. Insurance Services representative will contact you promptly with a quote for your requested coverage.

Personal Info

First Name*	MI	Last Name*
Address*		Home Phone*
		Work Phone
City, State, Zip*		Email*
How would you like us to contact you? Email: Phone:

Prior Policy

Have you had coverage during the past 12 months? Yes No
Policy Number		Policy Expiration Date
Company		Agency

Mooring

Mooring location:*

City:*

state:*

Operator Info

First Name*	MI	Last Name*
Date of Birth*		Gender*	Male Female
Driver's License Number		State*
Relation*		Marital Status*

Losses in the Past 5 Years?
Date	Description	Payment

Educational Courses Completed:

U.S.C.G. Aux

U.S.P.S.

Captain’s License

Primary Residence Status:*
Highest level of Education:*
Occupation:*

Add another Operator

Vessel

Year:*		Make*
Model:*		VIN Number*
Type:*		Ownership*
Length (in feet):*		*Purchase Price:Including Motor(s)**
Boat Type:*		*Corporate Owned: Yes No**

Protection Devices:*

None

Automatic Fire Extinguishers

Central Station Monitoring System

Alarm System (High Water/Fire/Theft)

No Strike Lightning System

Automatic Halon or CO2 system

Number of Additional Owners:* (Excluding resident relatives of the first name insured)

List Any Additional Owners:*

Motor info

Year:*		Make:
Model:		VIN Number
HP:*		Mooring Type:*
Motor Type:*		Fuel Type:*

Add another motor

Coverages

Include Medical Payments Coverage:		Yes No
*Liability (CSL):Requires a copy of your umbrella policy**
Personal Property: Enter an amount rounded to the nearest $100
Personal Property Replacement cost: Yes No
Trailer Coverage:*		Hull deductible*
Specific Navigation Desired:		Captain and/or Crew Coverage: Yes No
Dinghy Coverage: Yes No		Dinghy value:

Additional Information

Additional Information: Note: New Full Hauled-Out Marine Condition & Value Survey Required on Vessels 11 Years of Age and Older. May be required prior to 11 years of age at underwriter’s discretion.
Number of years Yacht Owner Experience:
Number of years Yacht Operator Experience:

How did you hear about us:

or call 866-372-9693

Home Insurance Products Customer Service Agents Rider School Program About Contact Privacy Policy Sitemap Disclaimer Link to our site
Insurance News Motorcycle News Motorcycle Events MAP to our office
If you see a barcode here 1111555, the barcode font is installed on your system. | Industry Links.
Web SQL Company Webmail

Operator #2 Info
First Name MI Last Name
Date of Birth		Gender	Male Female
Driver's License Number		State
Relation		Marital Status
Losses in the Past 5 Years?
Date	Description	Payment

Operator #3 Info
First Name MI Last Name
Date of Birth		Gender	Male Female
Driver's License Number		State
Relation		Marital Status
Losses in the Past 5 Years?
Date	Description	Payment

Operator #4 Info
First Name MI Last Name
Date of Birth		Gender	Male Female
Driver's License Number		State
Relation		Marital Status
Losses in the Past 5 Years?
Date	Description	Payment

Operator #5 Info
First Name MI Last Name
Date of Birth		Gender	Male Female
Driver's License Number		State
Relation		Marital Status
Losses in the Past 5 Years?
Date	Description	Payment

Operator #6 Info
First Name MI Last Name
Date of Birth		Gender	Male Female
Driver's License Number		State
Relation		Marital Status
Losses in the Past 5 Years?
Date	Description	Payment