Classic Coverage Quote Request

 

If you'd like a proposal for Classic Coverage, please complete this form and press the "Submit" button at the end for a no-obligation quote. If you prefer, you can call us at 1-860-449-5929, or call our office toll free at 1-800-959-3047. You can even download our application form, print it out and fax it to us at 1-860-449-5915 or send it by mail. We'll be happy to help you.

About Your Boat

Vessel Name:             Model:                  Length:            Year:  
Builder:                                                       Designer:
Boat Type: If Other: Motor Type: If Other             
Hull Material: If other:   Number of Engines:  Horsepower of Each:          
Max Speed:   Fuel: Gas Diesel Other
 Purchase Date:   Purchase Price:

 

 

 

 

 

 

 

 

 

 

 

 

 

About Your Boating

Mooring location:          City: State: ZIP:   Security Provided: Yes No
Lay up location:             City: State: ZIP:   Security Provided: Yes No
Present location:           City: State: ZIP:
Waters navigated:         
Annual lay up:                From: To: Wet Lay Up?....   If none, check here
Use of boat:
Private pleasure use only        Live aboard (primary residence)        Chartered (Six pack only, maximum 20 per year)
      Your years of boating experience:                       Your years of boat ownership:
      Previous boats owned: (type, length, number of years owned)

Power Squadron or USCG Auxiliary Course? Yes No
Do you have a Captains License? Yes No  Level
Member ACBS or other owner's club? Yes No      Name of Owner's Club
Do you have a Paid Captain? Yes No               Do you employ Paid Crew Yes No   If yes, Number 
Has your Marina asked to be listed as additional insured?  Yes No 
Is there a loan on your boat?  Yes No 

Next >>

 
 

 
 

 

 

 

 

 

 

 

 

 

 

 

 

About Your Coverage

Current or previous insurer :
Policy expiration:                  

Limits of Insurance Requested

Hull & Machinery $                     Marine Liability $

Tender $  Tender Mfg    Trailer $    Trailer Mfg  
Medical Payments $10,000 / Personal Effects $2,500 or other.... $
Deductible:
Claims (Please list dates and amounts):   No Claims 

 

 

 

 

 

 

 

 

 

 

 

 

About You

Name:        Age:             Email:    

Address, City, State, Zip:

Please list the names and ages of any other regular operators:
Name: Age:                         Name: Age:
Have you ever had boat insurance canceled or non-renewed?      No   Yes
If yes, please explain.
Daytime Phone: Evening Phone:
Fax Number:         Cell Phone:     
Other comments: (Please add as much detail as you wish)

 

Home / Classic Coverage / Tailored Protection / Request a Quote / Contact Us / Helpful Links
© Copyright 2006 - Heritage Marine Insurance