Boat and Yacht Quote - Tolleson Insurance

Select Your Agent*

Primary Insured's First & Last Name*

First Last

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Insured Cell Phone Number*

Do we have permission to text you about policy changes?*

Yes
No

Primary Insured Email*

Primary Insured Gender*

Male
Female

Primary Insured DOB*

Primary Insured Driver's License Number*

Driver's License State*

Boat Information

Length*

in feet

Year*

Manufacturuer*

Model*

Hull Material*

Type*

Engine Type*

Fuel Type*

Total Horsepower*

Speed*

Watercraft Storage Location*

Street Address Address Line 2 City State ZIP Code

Type of Storage*

Years of Experience Operating a Watercraft*

Principal Operator Boating Education Level*

Safety Course

Is this vessel a Personal Watercraft (a Jet Ski or Wave Runner versus a boat)?*

Yes
No

Is this vessel used for Private Pleasure Use Only?*

Yes
No

Is this vessel chartered?*

Yes
No

Is this a full-time live aboard exposure?*

Yes
No

Is this a houseboat that has salt water/coastal exposure?*

Yes
No

Have there been any boating losses in the last 3 years?*

Yes
No

Is the principal operator over 25 years old?*

Yes
No

Are there more than 2 unrelated owners/operators?*

Yes
No

Does this boat/yacht go faster than 75 mph?*

Yes
No

Are there more than 2 motor vehicle incidents per operator and/or 3 per household?*

Yes
No

Has this client's insurance ever been canceled, declined, or non-renewed?*

Yes
No

Does any operator have any criminal convictions(Arson/Burglary/DUI) within the past 5 years?*

Yes
No

Is the boat used on coastal waters of the Atlantic Ocean, the Pacific Ocean, or the Gulf of Mexico?*

Yes
No

The following questions apply to any watercraft to be insured on this policy - Check all that apply

Rented or leased to others?
Used for business purposes?
Previously salvaged?
Permanent living quarters?
High performance?
Homemade or kit?
More than two motors?
Exposed engine, other than outboard motors?
Owned by business?

Upload your current boat policy

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State law requires that the customer be informed that credit information will be used during the quote/application process and that the customer be provided with a copy of the current statement. This information may also be used to provide you with a quote for other insurance products we offer.

By submitting this form I certify that I have reviewed the application information contained herein. I verify that the information is true, correct and complete.

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