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Exclusively Offered by GIS

 

 

 

   

Quote Request Form

Name:                                            

Age:   

Date of Birth:  (mm/dd/yyyy)

 

NPAA #: 

 

Address: 

 

City/State/Zip: 

 

Phone Home/Work: 

 

Email: 

 

Watercraft Information

Year: 

 

Manufacturer: 

 

Model: 

 

Length: 

 

Hull Material Type 

                

              Fiberglass             Aluminum           Wood

              Bassboat               Runabout              Pontoon

              Deckboat              Other: 

Engine #1:  HP              Make                  Model                   Year

                                               

 

Engine #2:  HP              Make                   Model                        Year

                                               

 

     Trailer:   Year           Make

                    

 

Type:   

                Outboard    Water Jet   Inboard / Outboard

               Inboard        None

Trolling Motor:

                 lbs. of Thrust           Make             Model             Year 

                                                

 

Equipment:

     Depth/Fish Finder    Stainless Props       GPS

 

     Anti Theft Trailer       Anti Theft Boat      Anti Theft Prop

 

     VHf Radio                Vapor Detector    Auto Halon/CO2

 

Operator's Experience

        Years:      Owning:          Operating: 

 

Licenses Held:  

 

Previous Owned

Watercraft (including

Make, Model,

and  HP): 

 

Boating Courses

Completed

(Year):    

 

List Watercraft

Losses (Explain):  

 

Auto Violations

(Last 3 Years):     

 

Waters Navigated  (Check all that apply)   Inland Waters   Great Lakes     Canada

 

Intended Use  (Check all that apply)     Guiding    Tournaments   Recreation

                                                           

 

Purchase Information

          Date                     Total Purchase Price

                     

Coverage Desired

Hull and Equipment:  $ 

       O/B Motor #1:  $ 

       O/B Motor #1:  $ 

                   Trailer:  $ 

       Trolling Motor:  $ 

 

Personal Effects:  $   

Watercraft Liability:    

   $300,000       $500,000       $1,000,000

Deductible

            $500 (Standard)    

           $1,000 (Pro Angler/Guide Endorsement only)

 

Optional Coverage

     Advantage Plus

     Containment/Fuel Spill coverage

     Fishing Tournament Fee Reimbursement

     Pro Angler/Guide Endorsement

     NAVIGUARD MBI

 

Current Insurance

Issuing Company:   

Exp Date: 

Current / Renewal Premium 

 

 

       

 

    

 
 

Copyright  - © 2005 Greater Insurance Service Corp. 

  All rights reserved.