Petrov Lawrence Reed Insurance

Online Customer Service

Watercraft Quote Request

Please note: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member.

Effective Date:

Your Name:

Your Mailing Address:

Street

City, State & Zip

E-mail Address:

Daytime Phone #:

Choose One:

Please call me with quote premium.
Please send quote via e-mail.

Description of Property:

Motor type:	Number of Engines:	Boat Type:	Other Boat Type
Fuel:	Maximum Speed:	Hull Material:	Other Hull Material:

Insured Watercraft:

Boat:
Year	Manufacturer	Model

Serial Number		Length	TotalHP

Outboard Motor:
Year	Manufacturer	Model

Serial Number		TotalHP

Trailer:
Year	Manufacturer	Serial Number


Coverages:	Limits:
Boat (Including Auxiliary Equipment, please break down o/b information)
Outboard Motor 1. (ACV Coverage)
Outboard Motor 2. (ACV Coverage)
Boat Trailer
Personal Property ($500 Automatic)
Commercial Towing ($400 Automatic)
Boat Liability (ACV Coverage)
Medical Payments ($1000 Automatic with Liability)
Uninsured Boater
Optional Coverages	Agreed Value Endorsement Actual Cash Value Fishing Equipment - Limit:

Safety Equipment:
Check all that apply:

GPS
Automatic CO2 (Halon)
Ship to Shore Radio (VHF)
Depth Sounder
Electronic Burglar Alarm

Radar
Plotter
EPIRB
Vapor Detector Alarm

Operator Information:

Date of Birth:

Years of Boating Experience:

Waters to be Navigated:

Inland waters of the following states:	Coastal waters of the following states:
Is the boat chartered or used for other than private pleasure purposes? Yes No

Previous Loss Information:
Please describe any losses or claims filed on your Boat Insurance in the last 3 years.
Please include the date and type of the loss, as well as the amount of the claim

Comments:
Please use the box below to enter any additional information you wish to include:

Protecting your privacy and identity is very important to us.
Your social security number is required to complete this quote. Please be sure you have provided an accurate contact number so that we can contact you personally for this information.

If you have not received a response from us within one business day, please contact us again. Thank you.