GoldenRuleInsurance.com -Boat, Yacht & JetSki Quote Page

Boat, Yacht, & Jet Ski Insurance Quote Form Boat and personal watercraft coverage can vary greatly. You can count on Golden Rule Insurance to design a program that will cover you on and off the water. We are committed to offering the options you need like roadside emergency service, on-water towing, fishing equipment and rental equipment. Your Personal Data
Your Name:
Street Address:
City:
*State:
Zip Code:
E-Mail (REQUIRED):
Confirm E-Mail:
Phone:
Fax (optional):

Marital Status: Single Married	Homeowner? Yes No

Boat Currently Insured? (If yes, list carrier, and # of years continuous. If none, type N/C)

Is this Boat Co-owned? (If yes, list all owners names)

OPERATOR INFORMATION #1

Name:		Birthdate:

Sex (M/F):		# Years U.S. 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:		Number & Type of MINOR Cites last 3 years:

Number & Type of MAJOR Cites last 3 years:		Number of Years Boating Experience:

OPERATOR INFORMATION #2 (if none, leave blank)

Name:		Birthdate:

Sex (M/F):		# Years U.S. 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:		Number & Type of MINOR Cites last 3 years:

Number & Type of MAJOR Cites last 3 years:		Number of Years Boating Experience:

VESSEL & UNDERWRITING INFORMATION

Year of Boat:		Make & Model (be specific):

Boat Length:		Hull Type (wood, Metal, fiberglass, etc):

Max. Speed (in MPH):		Hull Value:	$

Engine Make:		Engine Type: (Inboard, I/O, Jet)

Engine Horse Power:		Fuel Type: (Gas, Diesel, etc.)

Trailer Cov. Needed?	Yes No	Yr./Make/Model of Trailer:

Trailer Value:	$	Where is boat moored or stored?

Describe waters boat taken on?		Describe boat general usage? (fishing, ski, etc.)

Total Value of Hull, Motor, and Trailer:		$



VESSEL COVERAGES:

Limits of Liability:	$25/50 BI / 25 PD $50/100 BI / 50 PD $100/300 BI / 100 PD $250/500 BI / 100 PD

Hull Coverage:	NO Coverage $250 Deductible $500 Deductible $1000 Deductible

Water Ski Medical Coverage?	Yes No	Uninsured Motorists Cov.?	Yes No

Comments or Remarks: (List additional drivers, special coverages, etc. here)



Send my quotation via:	E-Mail Fax Regular Mail Call me by Phone!

Thank you for filling out this form COMPLETELY! We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy. Yes, I Agree. Please Send Me a Boat Quote NOW! *Hawkins Insurance Group is licensed to sell in more than 20 states. If you are contacting us from a state in which we are not licensed, we will contact you to inform you that we cannot provide you with a quote.



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