Boat Insurance

Advantage auto insurance

 

 
On-Line Boat
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!
Your Personal Data

Your Name:
Street Address:
City:
State: MUST be California!
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 
Marital Status:
Single Married
Homeowner?
Yes No
 
Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type N/C)
 
How is Your Credit History?
(Some carriers use credit history to qualify)

DRIVER INFORMATION #1
Name: Birthdate:
Sex (M/F): # Years U.S.
 Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:
Number & Type of Accidents last 3 years: Number & Type of MINOR Cites last 3 years:
Number & Type of MAJOR Cites last 3 years: Daily commute
in ONE WAY miles:
Does Driver need
an SR22 FILING?		 Yes No If YES to SR22 filing, why needed?
(list accident/cite)

DRIVER INFORMATION #2 (if none, leave blank)
Name: Birthdate:
Sex: # Years U.S.
 Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations in fields below:
Number & Type of Accidents last 3 years: Number & Type of MINOR Cites last 3 years:
Number & Type of MAJOR Cites last 3 years: Daily commute
in ONE WAY miles:
Does Driver need
an SR22 FILING?		 Yes No Comments or
Remarks?

VEHICLE #1 INFORMATION
(if "Non-Owners", type "NON-OWNER" in "YEAR" Field)
Year of vehicle: Make & Model:
Annual Mileage: Used in business?
(Explain, if yes):
VEHICLE #1 COVERAGES:
Limits of
Liability:		 $15/30 BI / 10 PD $25/50 BI / 25 PD
$50/100 BI / 25 PD $100/300 BI / 100 PD
$250/500 BI / 100 PD $500,000 CSL
 
Comprehensive
Coverage:		 NO Coverage $250 Deductible
$500 Deductible $1000 Deductible
 
Collision
Coverage:		 NO Coverage $250 Deductible
$500 Deductible $1000 Deductible
 
Rental Car &
Towing Coverage?		 YES NO
 
VEHICLE #2 INFORMATION (if none, leave blank)
Year of vehicle: Make & Model:
Annual Mileage: Used in business?
(Explain, if yes):
VEHICLE #2 COVERAGES:
Limits of
Liability:		 $15/30 BI / 10 PD $25/50 BI / 25 PD
$50/100 BI / 25 PD $100/300 BI /100 PD
$250/500 BI /100 PD $500,000 CSL
 
Comprehensive Coverage: NO Coverage $250 Deductible
$500 Deductible $1000 Deductible
 
Collision
Coverage:		 NO Coverage $250 Deductible
$500 Deductible $1000 Deductible
 
Rental Car &
Towing Coverage?		 YES NO
 
Comments or Remarks:
(List additional drivers, autos, etc. here)

Send my quotation via: E-Mail Fax
Regular Mail
Call me by Phone!
Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a
Boat Insurance Quote NOW!

Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!