Debbie Milbery954-232-1661DMilbery@globalmarineinsurance.comIf you are human, leave this field blank.ReferralReferral SourceContact PersonPhoneEmailBoat & Yacht Insurance Quote FormFirst Name *Last Name *Primary ResidenceCityStateSelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip CodeMailing address (if different)Date of BirthDrivers License NumberHome PhoneCellFaxEmail *Marital StatusSelectMarriedSingleDivorcedWidowedOwnership StatusSelectOwn Home/CondoRentGenderSelectMaleFemaleOtherYear BuiltLength of VesselManufacturerModelHull IDPurchase DatePurchase Price (in USD)Number of engine(s)Select1234Maximum Speed (mph)Horsepower each engineEngine TypeSelectInboardInboard/OutboardOutboardPod/IPS/ZeusAir PropJetHull MaterialSelectFiberglassInflatableAluminumWoodSteelOtherFuel TypeSelectGasDieselElectricHas the applicant previously owned or operated other watercraft?YesNoIf yes then fill in the following details.MakeLengthOwned or Operated?OwnedOperatedYearsAny claims/losses within last five years?YesNoIf you had a loss please provide the following details.Date of LossCause of LossNature of LossAmount of Loss (USD)Has the applicant or any operator had any driving violations in the past 5 years?YesNoIf yes then tell us about the violation.Operator NameViolation DescriptionDate of ViolationAdditional Experience, Claims or Violations?If the applicant has owned more than one boat or has had additional claims or driving violations in the past 5 years provide details.Mooring AddressCityState/TerritorySelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip/Postal CodeRequested Navigation TerritorySelectInlandAtlanticPacificGulfGreat LakesChesapeakeBahamasCaribbeanVessel UsePrivate PleasureCharter (6 pack)Charter (Bare Boat)Live-aboardTypes of Storage:Selecton a liftrack storageon a trailer insideon a trailer outsidedock/slipLoss PayeeLoss Payee AddressTrailer YearTrailer MakeTrailer SerialTrailer ValueOB #1 YearOB #1 MakeOB #1 SerialOB #2 YearOB #2 MakeOB #2 SerialHull Value (less trailer value)P&I Liability$100,000$300,000$500,000$1,000,000TrailerMedical Payments$5,000$10,000$25,000Uninsured Boater$100,000$300,000$500,000$1,000,000Personal Effects$1,000$2,500$5,000$10,000Towing Coverage$500$750$1,000$1,500$2,500Submit
