Online Application

Our Boat/Yacht Application can be submitted to us in one of two ways. Electronically through our email application, or you can print out the application, fill it out and mail it or fax it to us.

For a printable Boat/Yacht Application form you can click on the link below, print it out, fill it out and mail or fax it to us.

>>>>>>Download Printable Application in Adobe Acrobat Form Here<<<<<

For submitting via email, fill out Boat/Yacht Application below and send it to us by clicking "SUBMIT" at the bottom of the form.

Applicant Information

Applicant  Co-Applicant
Applicant Email  Co-Applicant Email
Address   City   State   Zip  
Home Phone   Work Phone  
  (Applicant #1) (Applicant #2)
Name
Birth Date/Marital Status DOB   MS  DOB   MS 
Driverís License #
Violations/Accidents
Social Security #
Occupation
Employer
Years Boating Experience
Describe Boats Owned/Operated
Prior Boating Losses/Claims
Prior or Current Carrier
Safety Courses YES   NO YES   NO
Course Description
List All Other Operators
VESSEL INFORMATION
Hull Year   Length   Make   Model 
Serial #   CF#   Value $   Purchase Date 
Hull Design:   V   Semi V  Deep V  Cat  Tunnel  Pontoon
Hull Material:   Fiberglass  Wood  Metal  Aluminum  Other 
Engine Year:   Manufacturer:    Single   Twin  Horsepower: 
Engine ID# (Eng 1):   Engine ID# (Eng 2):  
Propulsion:  Outboard  I/O  Inboard  Jet  Sail  Max Speed:   Fuel:Gas  Diesel
Trailer Year:    Manufacturer  ID# 
Number of Axles:3  Trailer Value: $ 
Mooring Location:   State:  County:  Zip: 
Storage Location:   State:  County:  Zip: 
How Protected from Theft:  
Navigational Area:  
Vessel will be used for:  Private/Pleasure  Business/Entertainment  Racing Charter 
    For Profit/Non-Profit Organization  Minors will operate  Fishing Guide  Commercial Fishing
     Vessel currently for sale  Live-a-board 
Electronic Aids:  Halon  VHF  Loran  Depth Sounder  Radar  Fume Detector  Automatic Bilge Pump  GPS  Auto Pilot 
Tender Mfg:   Tender Value $:  Tender ID#:  Tender Engine Mfg:  Tender Engine H.P.:  Tender Engine ID#: 
Lender:  
Additional Insured:  

NOTICE: Fraud warning (required by law in certain states):  Any person who, with intent to defraud or knowing that he or she is facilitating fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.  Concealment, misrepresentation, or fraud:  Any fraudulent statement misrepresentation or failure to disclose material information in the negotiation of this policy will render the insurance voidable from inception and enable the company to repudiate liability.  Applicantís statement:  I have read the above application and I declare that to the best of me knowledge and belief all of the forgoing statements are true, and that these statements are offered as an inducement to the company to issue the policy for which I am applying.

by typing your full name in the box below you are agreeing to the above NOTICE:

 NAME:   DATE: