BOAT QUOTE

Please take the time to fill out the following questionnaire to the best of your knowledge.  A quote will be returned to you ASAP!!!

NAMEEMAIL ADDRESS

ADDRESS

ZIP CODE

COUNTY

                                      YEAR             MAKE/MODEL            VALUE 

BOAT                      

MOTOR                  

TRAILER                

TYPE OF MOTOR

LENGTH                     

HORSEPOWER        

MAXIMUM SPEED       

TYPE OF BOAT      

IS OPERATOR'S MVR CLEAR? 

ANY OPERATORS UNDER 21? 

*PLEASE LIST NAMES AND AGES OF ALL OPERATORS IN REMARKS SECTION.

WHERE IS THE BOAT STORED?

WHAT DEDUCTIBLE? 

COVERAGES:

    BI         PD     

    MED PAY

    COMPREHENSIVE

    COLLISION 

    UNINSURED BOATERS 

    TOWING 

    SKIERS LIABILITY 

ANY OTHER INFORMATION PERTINENT TO YOUR QUOTE!

REMARKS: (DON'T FORGET TO LIST ALL OPERATORS)

I prefer to be contacted by:

Thank you for filling out the above quote application.  We will get back to you ASAP!!!

***NOTE:  This sheet can also be filled in, printed out, and faxed to us at 205-988-0379.

 

2032 Valleydale Road

Birmingham, Alabama 35244

205-988-0800

Toll Free:  1-800-476-0801