5405 Chena Ave, #4
Anchorage, AK 99508

Phone: 907- 337-2311
Toll Free: 800-770-2311
Fax: 907-338-6344

 
   

 

 

 
  Request a Quote - Boat

Complete the following information. Upon review of the information we will contact you. If you have questions please Contact Us.
Instructions:
  1. Complete the form as thoroughly as possible
  2. Items marked with * are required
  3. The information you provide in this form will be used to prepare a quote for you
Contact Information:

Name: *
Mailing Address:
Street

City

State

Zip
Please provide an email address or phone number *
E-mail Address:
Daytime Phone:
Contact Method:  Please call me with quote premium.
 Please send quote via e-mail.

Description of Property:
Motor type * Number of Engines *
Boat Type * Other Boat Type
Fuel * Maximum Speed *
Hull Material * Other Hull Material

Insured Watercraft:
Boat
Model Manufacturer Year
* * *
Serial Number Length Total HP
* * *
Outboard Motor
Model Manufacturer Year
Serial Number Total HP
Trailer
Manufacturer Serial Number Year

Coverage's& Limits:
Boat (Including Auxiliary Equipment, please break down o/b information)
Outboard Motor 1 (ACV Coverage)
Outboard Motor 2 (ACV Coverage)
Boat Trailer
Personal Property($500 Automatic)
Commercial Towing($400 Automatic)
Boat Liability(ACV Coverage)
Medical Payments($1000 Automatic with Liability)
Uninsured Boater
Optional Coverage's
Agreed Value Endorsement Yes No
Actual Cash Value Yes No
Fishing Equipment Yes No  Limit:  

Safety Equipment: Check all that apply:
GPS Yes No Automatic CO2 (Halon) Yes No
Ship to Shore Radio (VHF) Yes No Depth Sounder Yes No
Electronic Burglar Alarm Yes No Radar Yes No
Plotter Yes No EPIRB Yes No
Vapor Detector Alarm Yes No

Primary Operator Information:
Date of Birth *
Years of Boating Experience: *

Secondary Operator Information:
Date of Birth *
Years of Boating Experience: *

Waters to be Navigated:
Inland waters of the following states:
Coastal waters of the following states:
Is the boat chartered or used for anything other than private purposes? Yes No*


Previous Loss Information:
Please describe any losses or claims filed on your Boat Insurance in the last 3 years. Include the following information: date of loss, type of loss and amount of claim.

Additional Comments:
Please use the box below to enter any additional information you wish to include.

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