TRUSTED SOURCE SINCE 1989
Boat & Yacht Insurance Quote Request
Owner Information
Owner Name:
Address:
 Phone:
Full Physical Address - No PO Boxes please
City, State Zip:
 Email:
Any prior insurance losses?
 If yes, pls give details:
Expiration date of current policy:
Owner date of birth:
 Owner Driver Licence Number:
 Coast Guard Licence?
Years of boating experience:
Please describe any prior boats owned/operated:
Vessel Information
Year:
Manufacturer:
 Length:
 Model:
Purchase Price:
 Desired Amount of Hull Coverage:
 Hull Material:
How many engines?
 Fuel Type:
 Engine Mfg:
Engine Year of Mfg:
 Engine Horsepower (each):
 Desired Coverage
for engines(s):
Trailer Year of Mfg:
 Trailer Manufacturer:
Trailer Value:
Where will your boat be moored/stored/berthed?
(If at a Marina, pls give name, city & state)
Safety Equipment, If any:
 Do you have a tender/dinghy?
If so, please give details
Operation of Vessel
Waters to be Navigated:
Is there a layup period?
During lay up period, vessel is decommissioned:
Charter Information
Skip this unless you charter your boat/yacht
Do you charter this boat?
 If you charter, Please answer the following:
Number of days chartered annually?
 Maximum number of passengers:
 Does anyone liveaboard
this vessel?
Dealership Information
Dealer
Phone:
Name of Dealership:
Dealer
Contact:
Dealer
Contacts Email:
Lienholder Name & Address (if known):
Notes to our Agency
Thank you for your business!
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Copyright 2007 Tom Stewart Insurance
Need Help? Call us at (281) 589-0004 or (800) 324-8577
Quotes available in Texas, Louisiana,
Mississippi, Alabama, Georgia, South
Carolina, North Carolina, Virginia, Maryland,
Ohio and Arizona, Arkansas, Tennessee.
May 2008 - Other states are now
being added due to demand.