Walock-Johnson Insurance, Inc. :: Boat Insurance Quote Request

Boat & Watercraft Quote Request

It will be our privilege to provide you with a free, no-obligation insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

Contact Information

Name

Email Address

REQUIRED

Telephone Number

Preferred Method of Contact

Street Address

City or Town

State

ZIP Code

Operators

List names along with their date of birth and if each operator has completed Coast Guard Auxiliary or Power Squadron course:

Boat Information

Is the boat currently insured?

If yes, when does the policy expire?

Type of boat:

What is it used for?

Where is vessel stored?

Waters navigated?

Hull Information

Year Built:

Make and Model:

Hull Type:

Length:

feet

Estimated Market Value:

Maximum Speed:

miles per hour (MPH)

Personal Effects?

(value)

Engines

#1 Engine Year & Make:

Type:

Fuel Type:

Estimated Value:

$ (Outboard only)

Horsepower:

#2 Engine Year & Make:

Type:

Fuel Type:

Estimated Value:

$ (Outboard only)

Horsepower:

Trailer

Trailer?

Make:

Value:

Liability Coverage

Liability Coverage:

Medical Payments:

Waterski Medical Needed

Has any listed operator been
nvolved in a boating accident
within the past 5 years?

If yes, please provide details:

Has your boat and/ or equipment
suffered damage from any cause
within the past 5 years?

If yes, please provide details:

Has any listed operator been involved
in an auto accident or received a moving traffic citation within the past 3 years?

If yes, please provide details:

Additional Comments

Rutland 701-724-6484		Lisbon 701-683-5253		Milnor 701-427-5215		Gwinner 701-678-2771