Your Contact Info

First Name Last Name

Email

Your Phone Number?

Best Time to Call? AM PM any time

Boat Info

Are you newly buying the boat? Yes No

If yes, please list the anticipated closing date and purchase price.

Policy Owner's Full Name(s)?

Year of boat's manufacture?
Manufacturer? Model number?

Length of hull? Rated Speed?

Please check the features which apply to your boat:

outboard inboard/outboard inboard

wood fiberglass sailboat

Waters Navigated: Salt Water Fresh Water Both

Model and value of boat equipment? (GPS, fish finders etc.)

Boat yard address?

Please list any boat losses or operator license suspensions that have occured in the past 6 years

Motor Questions

Motor Manufacturer?
Model Year
Model Number
Horsepower?
Number of engines?

How did you hear about Beacon Insurance?

Web search Print Ad Local Yellow Pages

If a friend, what's their name?

If an agent, please list the agent's name here