Boat Insurance Quote

Boat Insurance Quote

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Personal Information
Owner's Name First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Email
Insurance Information
Current or most recent insurer:
Policy renewal date or last date insured: / MM / DD YYYY
# of Driver’s in household:
Please list names:
Primary Driver's Marital Status: Married Single
Primary Driver's Birth Date / MM / DD YYYY
Approved Safety Course Completed? Yes No
Boat Information
Serial Number:
Make and Model:
Year:
Mooring Zip Code:
Length:
Maximum Speed?
Hull Material? Aluminum Fiberglass
Hull Value:
Hull ID Number:
Motor Information
Number of Motors:
Make/Model:
Year
Motor Type: Jet Power Non-power
Motor Location Outboard Inboard/Outboard Inboard
Horsepower:
Trailer Information
Make/Model
Year:
Value:
Coverages:
Physical Damage Actual Cash Value Agreed Value No coverage, liability only
Collision Deductible $250 $500 $1000 No coverage
Comprehensive Deductible: $250 $500 $1000 No coverage
Bodily Injury: $100,000 CSL $300,000 CSL $500,000 CSL
Uninsured Boaters: $100,000 CSL $300,000 CSL $500,000 CSL
Medical Payments: $1,000 $2,500 $5,000
On Water Towing: $300 $500 $1000
Personal Effects: $1000 $2000 $3000 $4000 $5000
Violation Information
Have any driver’s had any violations? Yes No
If yes, list:
Date/Type of violation/Which Driver:
Have any drivers had any claims? Yes No
If yes, list:
Date/Type of claim/Driver:
Any additional information:
How did you hear about Key Agency?


BOCA GRANDE, FL 428 4th Street West, Unit B Boca Grande, FL 33921 Tel: 941.964.1500 Fax: 866. 224.1422 E-mail this office	ENGLEWOOD, FL 1201 S. McCall Rd. Englewood, FL 34223 Tel: 941.474.9511 Fax: 941.474.7283 E-mail this office	NORTH PORT, FL 14942 Tamiami Trail Suite H North Port, FL . 34287 Tel: 941.429-9709 Fax: 941.429.0287 E-mail this office

Key Agency, Inc., Independent Insurance Agency
Family Owned & Operated Since 1952

For all your

Insurance needs

Key Agency, Inc. will provide you with a no cost,
no obligation review and comparison of your insurance.