Thurston Insurance

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On-Line Boat Insurance Quote Form
Your Personal Data:
*Your Name
*Street Address
*City
*State
*Zip Code
*E-Mail
E-Mail (repeat)
*Phone
fax(optional)
 

Marital status
Homeowner?
Boat Currently Insured?
(If yes, list carrier, and # of years continuous, if not, leave blank or write "no")
is the boat co-owned?
(If yes, list all owner's names)

Operator Information #1
*Name
*Birthdate
sex
*# Years US Licensing
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" (carriers require proof on NOT-at-fault accidents).
Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:
*Number & Type of Accidents last 3 years (enter 0 if none)
*Number & Type of MINOR Accidents last 3 years (enter 0 if none)
*Number & Type of MAJOR Accidents last 3 years (enter 0 if none)
Number of years boating experience

Operator Information #2 (if none leave blank)
Name
Birthdate
sex
# Years US Licensing
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" (carriers require proof on NOT-at-fault accidents).
Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:
Number & Type of Accidents last 3 years (enter 0 if none)
Number & Type of MINOR Accidents last 3 years (enter 0 if none)
Number & Type of MAJOR Accidents last 3 years (enter 0 if none)
Number of years boating experience

Vessel & Underwriting Information
Year of boat
Make and model of boat
Length of boat
Hull type
Max. speed in MPH
Market value (in $)
Engine make
Engine type (Inboard, I/O, Jet)
Engine Horse Power
Fuel type (Gas, Diesel, etc.)
Trailer Coverage needed?
Year, make and model of Trailer
Trailer value (in $)
Where is boat moored or stored?
Describe waters boat taken on
Describe boatgeneral usage? (fishing, ski, etc.)

Vessel coverage
Limits of Liability
Hull Coverage
Water Ski Medical Coverage?
Uninsured Motorists Cov.?

Comments or remarks
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Thank you!