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.*
 
 
 
 
 
 
 
Boat Quote Request
 
 
 
 
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:*
 
 
 
 
We apologize that coverage is not available in New York.
 
 
 
How did you hear about us?*
 
 
 
 
If Agent, who is the agent?
 
 
 
 
 
 
 
Boat Information
 
 
 
 
 
Model Year:*
 
 
 
 
Boat Type
 
 
 
 
Length (in feet):*
 
 
 
 
Manufacturer*
 
 
 
 
Model:*
 
 
 
 
Horsepower*
 
 
 
 
Maximum Speed:
 
 
 
 
Current market value (including motor):
 
 
 
 
What is the weight of your boat (in pounds)?
 
 
 
 
What type of engine powers your boat?*
 
 
 
 
Number of Engines:
 
 
 
 
If the boat is moored, please provide the Zip Code of its location
 
 
 
 
 
 
 
Coverages and Limits
 
 
 
 
 
We offer liability only and full coverage policies. Which do you prefer?*
 
Liability Only
Full Coverage
 
 
 
 
 
 
Select your desired amount of liability coverage. The numbers represent the amount of coverage on the policy per person/per accident/per occurrence. Higher and lower limits are available, but these are the most common.*
 
 
 
 
Full coverage policies can also protect boat trailers. If you need coverage for these on your policy, select here:
 
Yes
No
 
 
 
Full coverage policies can also protect boat lifts. If you need coverage for these on your policy, select here:
 
Yes
No
 
 
 
Full coverage policies can also protect tenders/dinghies. If you need coverage for these on your policy, select here:
 
Yes
No
 
 
 
Please tell us the amount of coverage you want for your trailer/tender/dinghy/boat lift.
 
 
 
 
Do you have experience operating boats?
 
Yes
No
 
 
 
If yes, how many years of boating experience do you have?
 
 
 
 
Is the boat/PWC currently insured? If so, you may qualify for a discount. *
 
Yes
No
 
 
 
If yes, who is your current insurance company?
 
 
 
 
Do you insure your boat with a separate/standalone policy, or do you endorse your boat onto your homeowners or auto insurance policy?
 
 
 
 
Have you had any losses or claims on this boat/PWC in the last three years? *
 
Yes
No
 
 
 
Have you been involved in any water-related violations in the last three years? *
 
Yes
No
 
 
 
In the last three years, have you had any minor or major moving violations that are not watercraft related? *
 
Yes
No
 
 
 
 
 
 
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.
 
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