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Vessel Type AirboatBass BoatCrusierHouseboatPontoonRunaboutSailboatSki BoatSportfishingTrawler
Number of Engines No Engine1 Engines2 Engines3 Engines4 or more Engines
Type of Engines NAInboardInboard/OutboardOutboardJet
Fuel Type NAGasDiesel
Is Vessel Stored at your Residence? YesNo
Date of Birth
Sex MaleFemale
Marital Status SingleMarried
Liability Coverage $100,000$300,000$500,000$1,000,000
Medical Coverage $1,000$5,000$10,000
Property Damage $5,000 each accident$10,000 each accident$25,000 each accident$50,000 each accident$100,000 each accident
Do you currently have insurance? YesNo
How long have you had uninterrupted Insurance Coverage? No coverage3 months6 months1 years2 years3 years or more
What is the expiration date of your current policy?
When would you like to have this policy start?
Uninsured / Underinsured Motorist None$15,000 person, $30,000 per accident$25,000 per person, $50,000 per accident$50,000 per person, $100,000 per accident$100,000 per person, $300,000 per accident$250,000 per person, $500,000 per accident
