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Watercraft Quote Request
Requested Effective Date:
Your Name:
Your Mailing Address:
 Street

City, State, Zip
  
E-mail Address:
Daytime Phone #:
Best way to contact me: Please have a licensed agent contact me to gather the required information.
I am completing the information requested below, please have a friendly licensed agent contact me.
Description of Property:
Motor type:
 Number of Engines:
 Boat Type:
 Other Boat Type
Fuel:
 Maximum Speed:
 Hull Material:
 Other Hull Material:
Insured Watercraft:
Boat:
Year
 Manufacturer
 Model
Serial Number
 Length
 TotalHP
Outboard Motor:
Year
 Manufacturer
 Model
Serial Number
 TotalHP
Trailer:
Year
 Manufacturer
 Serial Number
Coverages:   Values:
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 Coverages
 Agreed Value Endorsement
Actual Cash Value
Fishing Equipment - Value:  
Safety Equipment:
Check all that apply:
GPS
Automatic CO2 (Halon)
Ship to Shore Radio (VHF)
Depth Sounder
Electronic Burglar Alarm 		Radar
Plotter
EPIRB
Vapor Detector Alarm
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 other than private pleasure purposes?    Yes     No

Previous Loss Information
Please describe any losses or claims filed on your Boat Insurance in the last 3 years. Include the date and type of the loss, as well as the amount of the claim
Additional Comments
Please use the box below to enter any additional information you wish to include:
Protecting your privacy and identity is very important to us. 
Your Social Security number and Drivers License number may be required to complete this quote.  We will contact you personally for this information.
        

If you have not received a response from us within one business day, please contact us again. Thank you.
 
Babbitt-Sholund Insurance  201 E. Bell Street, Neenah, WI  54956  •  Phone: (920) 722-7531  Toll Free: (800) 236-8600
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