<a href="http://www.macromedia.com/go/getflashplayer">Flash Required</a>
Flash Required
Local & Worldwide
Yacht Insurance Coverage:

Obtain the Broadest Coverage
at the Best Price.
1 . 800 . 490 . 4058fax  405 . 840 . 4655
WATERCRAFT QUOTE FORM - Complete and submit this form. We will respond with a quote within 48 hours.
  Name to  be used on Policy:

  Phone Number:   Email Address:

  Mailing Address:

  City:  State:  Zip:

  Beneficial Owner's Name:    Date of Birth:                            (mm/dd/yyyy)

  Occupation:Nationality:

  Other entities or individuls having financial interest in this yacht:


Yacht To Be Insured
 
   Year Built:Length:Manufacturer:

   Type:Construction Material:

   Tonnage: Total Horsepower: Fuel:

   Fuel Tank Material:

   Engine Manufacturer:Engine Model:

   Vessel Name:Effective Date of Coverage:         (mm/dd/yyyy)

   Hull Insured Value: $Hull Deductible: $

   Liability Limit: $Increased Personal Effects: $  
  

  Tenders (must be carried on board and used only to service the megayacht):

   Year:Manufacturer:

   Tender Length:Horsepower:Value: $

  
   Personal Watercraft:

   How Many?    Year:     Length:   Manufacturer:
 
   Port of Registry:
Mooring/Navigating Area:

   Home Port Spring/Summer:   Home Port Fall/Winter:

   Requested areas of navigation: (check all that apply)













    One Year Itinerary:






Crew Information:

   Total number of full-time paid crew:   Total number of part-time/occasional paid crew:

  Paid Crew Members: (check all that apply)










  
Captain's Name:
Loss/Survey Information:

   Do you (the insurer) have any previous loss history?
   If yes, please provide dates, description and amounts:






  
    Does the Captain have any previous loss history?
    If yes, please provide dates, description and amounts:






   
    Does the yacht have any previous loss history?
    If yes, please provide dates, description and amounts:






  
   Is a copy of the survey available?
   If yes, you are required to provide us with a copy.

   Have all recommendations been complied with?

   If you are not the original owner, what was the purchase date of the vessel?    (mm/dd/yyyy)

   Is a copy of the pre-purchase survey available?

  Have all recommendations been complied with?

   Original purchase price: $

   Name of current/previous insurance carrier:

    Names of previously owned vessels:

   Has your insurance ever been non-renewed?

  If yes, please provide details:

Loss Payee:

    Name:

    Mailing Address:
   
    City:State:Zip:

    Breach of Warranty required:


   If yes, how much of loan? $


Additional Watercraft:

    Year:Length:Manufacturer:   Model:Value:


    Year:Length:Manufacturer:   Model:Value:

    Are any of these watercraft towed behind the large yacht?


A quotation or policy issuance for this yacht is based upon inforamtion provided by the producer and prospective insured and is subject to receiving the Captain's resume, the one year itinerary and a current survey (if applicable), within thirty (30) days from the binding coverage date.
(policy automatically provides $25,000 in Personal Effects Coverage)
East Coast of the United States
Gulf Coast of the United States
West Coast of the United States
Bahamas, Turks & Caicos
Newfoundland Island, Canada
Vancouver Island, British Columbia, Canada
Panama Canal Transit
Island waters of the United States and Canada
Mexico
Alaska
Bermuda
Eastern Caribbean, not south of Grenada
Western Caribbean, not south of Grenada
Mediterranean
Other
First Mate
Captain
Engineer
Deckhand
Full-timePart-time
Full-timePart-time
Full-timePart-time
Chef
Steward/Stewardess
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo