Yachts For Sale
INSURANCE QUOTE
We would like to provide you with a free, no obligation yacht/boat insurance quote from Cox Insurance Sevices. Please note that this quote will only be as accurate as the information that you provide us.
General Information
Name: Last, First, MI.
Address:
City:
State: ZIP:
County:
Email:
Home Phone :
( )
Work Phone :
Best time to call:
AM/PM AM PM
Current Boat/Watercraft Insurance Information
Coverage's
(include only for those insurances required)
Type
Sums Insured
Vessel Information
Miscellaneous
(please check ALL that apply)
Primary Power
Type of Hull
Hull Material
Fuel Tank
Engine/Outboard Motor Information
(please complete for each engine)
Eng
H.P.
Gas
Diesel
Year
DatePurchased
PurchasePrice
Present Value
1
$
2
Trailer Information
Date Purchased
Purchase Price$
Present Value $
Manufacturer/Model:
Operators
(always list insured as Operator #1)
#
Name
DOB
Auto DL #
State
USCG / Power SquadronCertificate
Auto Violations / Suspensions / Accidents in last 3 years:
Years of Boat Ownership:
3
Boat/Watercraft Usage
4
Additional Comments
When Finished - Please click the "Submit " button to send your quote request.