Insurance Score / Claim History Disclosure
In connection with this application for insurance, we may review your credit report or obtain or use a credit-based insurance score based on the information contained in that credit report. We may use a third party in connection with the development of your insurance score. In connection with this application for insurance, we may review your claims history or loss experience and may report future claims made by you to a claims history provider. 
 
 
 
Applicant agrees to these terms.*
 
 
 
 
 
 
 
Snowmobile Quote Form
 
 
 
 
When you fill out and submit this form, one of our agents will take your information and provide you a quote within two business days. If you would like an immediate quote, call 1-866-884-6167 Mon - Fri 8 a.m. - 8 p.m ET.

This form allows you to provide information for one boat. If you have two or more boats, we can insure them – just call us!

All fields marked with an asterisk are required. You may find it useful to have your current policyor declarations page handy.
  
 
 
 
First Name*
 
 
 
 
Last Name*
 
 
 
 
Email*
 
 
 
 
If you do not have an email address, please give us a call at 866-880-8651. 
 
 
 
Date of Birth (mm/dd/yyyy):*
 
 
 
 
Address*
 
 
 
 
City*
 
 
 
 
State*
 
 
 
 
Zip Code:*
 
 
 
 
How did you hear about us?
 
 
 
 
If Agent, who is the agent?
 
 
 
 
What date do you want your coverage to take effect (mm/dd/yyyy)?*
 
 
 
 
How many years have you operated snowmobiles?
 
 
 
 
 
 
 
Vehicle Information
Vehicle Type:
 
 
 
 
Current market value:*
 
 
 
 
Model Year:*
 
 
 
 
VIN Number:*
 
 
 
 
Make:*
 
 
 
 
Model:*
 
 
 
 
Manufacturer*
 
 
 
 
Engine size (cc's): *
 
 
 
 
Is the cycle/unit currently insured? *
 
Yes
No
 
 
 
If yes, who is your current insurance company?
 
 
 
 
Is the vehicle kept in a secure location (i.e. locked garage) at night? *
 
 
 
 
If Other, please explain.
 
 
 
 
Are you the titled owner? If not, DO NOT SUBMIT*
 
Yes
No
 
 
 
Are snowmobiles used for racing?*
 
Yes
No
 
 
 
Have snowmobiles been modified for racing? (i.e. engines, exhaust, track, or suspension modifications other than factory recalls)
 
Yes
No
 
 
 
Are any of the snowmobiles used for business?*
 
Yes
No
 
 
 
Are any of the snowmobiles rented to others?*
 
Yes
No
 
 
 
Are any of the units used on public streets, roads or highways?*
 
Yes
No
 
 
 
Are any units used on unfrozen water? *
 
Yes
No
 
 
 
 
 
 
Accident/Violation Information
 
 
Thinking about the past three years of your driving record, please indicate the number of each type of violation that you have. Note that we do verify this information when a policy is purchased.
 
 
 
Number of minor violations: *
 
 
 
 
Number of major violations: *
 
 
 
 
Number of at-fault violations: *
 
 
 
 
 
 
 
 
 
 
Please provide the following information so we can contact you with your quote.
We respect your privacy and will never sell or rent your contact information to third parties.
 
 
 
 
 
 
How would you prefer that we contact you?*
 
 
 
 
Daytime Phone Number
 
 
 
 
Alternate Phone Number
 
 
 
 
 
 
 
Best Time to Contact
 
 
 
 
 
 
 
American Modern may periodically email you news and information related to specialty insurance products.
 
 
 
If you prefer not to receive these communications, please opt-out here.
 
Opt-In
Opt-Out