Personal/Commercial Airboat Insurance quotation request.

 Basic information
Insured Name
Address line 1 
Address line 2  
City, State/Province
Zip/ Postal 
Country 
email
Telephone-Work* 
Telephone-Home*    
Telephone-Other*  
Facsimile/Telecopier*

* We need at least one contact telephone number in case we need to clarify an answer.

Personal information for principal operator

Date of birth MMDDYYYY*  
Gender
Your marital status
Your occupation
Training you have had in your lifetime.*  
Can you prove it? (Do you have a copy? Even if expired)    
How many years have you operated airboats?*  If less than 1 show 1
How many years have you owned airboats?*   If less than 1 show 1.
Read carefully    Select any of the following that apply.
moving traffic violations last 5 years
felony (criminal) convictions ever
OUI/DUI/DWI convictions ever
losses last 10 years
insurer cancellations or non-renewals last five years
If you answered "YES" to any of the above, please explain in detail
Are there other REGULAR operators? Click here for an explanation.
NOTE We may request additional information on those operators and if so it will be in the same format as above.

Airboat information

All information below is required

Primary vessel use 
Airboat manufactured by
Model name or number
Seating capacity including operator
Hull color
Length 
Beam
Depth
Year built
Hull material
Hull sheeted with polymer
Fuel tank material  

Machinery data  
Engine manufactured by 
Model 
Type of  engine
Year of engine
Total HP, KW or CC's  
Last overhaul 
Fuel type
Maximum airboat speed in mph
Airboat total weight
Propeller manufactured by
Propeller year
Propeller maximum RPM
Propeller length
Propeller pitch
Where will you mainly use your airboat in the next 12 months?
Where will you keep your airboat when she is not in use? If outside, is she covered? If inside, advise building construction.
In the next 12 months
Will your boat be laid-up?        If No click here for next section
If Yes show approximate dates
If Yes where will she be laid-up? If outside, is she covered? If inside, advise building construction. 
Is your airboat?
Chartered or loaned to others?
Used commercially?
Corporately titled?
Used for business purposes?
Used for waterskiing?
Held for sale?
Used for racing?
Coverages requested (if coverage not required enter "0")
Boat coverage amount
Personal Effects amount
Trailer coverage amount  Please provide details in Remarks
Liability amount Some limits may not be available
  If you have a trailer, in Remarks tell us the year, make, model, and number of axles. You're done. Thanks

Remarks Remarks Remarks Remarks Remarks Remarks Remarks

Please add your comments here to elaborate on information provided to tell us more about your situation or coverage options you require.

Important note: Please review entire submission carefully before submitting this form as false information may void your insurance. Submitting this form does not bind you to purchase the insurance or any Insurer to accept the risk, however it is agreed that the information submitted shall be the basis of the quotation and contract should coverage be bound and/or a policy issued. No coverage is bound or in force until confirmed in writing by our office. The information collected from you is used to underwrite coverage and services. This information will be provided to others.  I have read the Important Information and understand and agree with the contents thereof.

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