Cox Agency "Service is First"                                                     

Home
Up

 

      

Yachts / Boats / Watercraft
INSURANCE QUOTE

We would like to provide you with a free, no obligation yacht/boat/watercraft insurance quote. Please note that this quote will only be as accurate as the information that you provide us.

General Information

Name: Last, First, MI. 
Address:
City:    State:    ZIP:
County:    Email:
Home Phone : ( )              
Work Phone :  ( ) 
Best time to call:    AM/PM

 

Current Boat/Watercraft Insurance Information

Company Name (not agency):
  Policy Expiration Date:    Premium Amount: $
Term: 6 Months   1 Year   Other:

Coverage's

(include only for those insurances required)

Type

Sums Insured

Type

Sums Insured

Hull- Physical Damage $ Tender / Dinghy $
Liability Coverage $ Medical Payments $
Non-Emergency Towing $ Uninsured Boater $
Personal Property $ Other $

 

Vessel Information

Vessel Name:
 Manufacturer/Model:
 
Year
  
Length
 Date
Purchased
 Purchase
Price
$		 Present
Value
$		 Max
Speed
mph		  
Waters to be navigated: salt water, fresh water or both
Tenders or Dinghies:
 Storage Address (Street, City, Co., St.):

 

LAID UP:
From: to 		On Shore
Afloat
Stored on Trailer:
Y   N

Miscellaneous

(please check ALL that apply)

Primary Power

Type of Hull

Hull Material

Fuel Tank

Sail Sailboat Wood Metal
Outboard Performance Metal Fiberglass
Inboard Runabout Fiberglass Plastic
Inboard/ Outdrive        

Engine/Outboard Motor Information

(please complete for each engine)

Eng

H.P.

Gas

Diesel

Year

Date
Purchased

Purchase
Price

Present Value

1

$

$

2

$

$

  Manufacturer/Model

1

2

Trailer Information

Year

Date Purchased

Purchase Price
$

Present Value $

Manufacturer/Model:

Operators

(always list insured as Operator #1)

 # 

Name

DOB

Auto DL #

State

USCG / Power Squadron
Certificate

1

2

#

Auto Violations / Suspensions / Accidents in last 3 years:

Years of Boat Ownership:

1

2

3

Boat/Watercraft Usage

 # 

Explain all YES responses below Y/N

 # 

Explain all YES responses  Y/N

1

Is the boat used for racing? Y
N

2

Was any operator involved in a marine loss in the last 3 years (insured or not)? Y
N

3

Is the boat used commercially or for business purposes? Y
N

4

Was any coverage declined, cancelled or non-renewed during the last 3 years? Y
N
REMARKS - Please explain any "Yes" Responses From This Section

Additional Comments

Please include any notes you feel might be appropriate for this quotation. If you have additional information and there was not enough fields above, such as additional operators, coverages, etc..., please enter them here.

 

When Finished - Please click  the "Submit " button to send your quote request.
One of our agents will respond to your submission as soon as possible.

    

 

 
  
Please Notice: Cox Agency cannot bind, modify or cancel coverage via submissions to our website, or by messages sent through e-mail. Completion and submission of this form or e-mail does not constitute either a binder or an application for insurance. This site provides quotes and information only. An application signed by you and our agent is required for insurance to become effective.