Yacht Insurance Quote

Please note that Shorepoint Insurance Services only provides yacht insurance for yachts whose hull value is equal to or greater than $250,000.

We will return a quote as quickly as possible via Internet or fax. You will receive an e-mail copy of the information on this form almost immediately after submitting the form. Please double-check your e-mail address for accuracy.

Yes! Please contact me, and give me a Free Explanation and Yacht Insurance Quote!

Contact Information

Name	Age
Street Address
City State or Province Zip Code
Occupation	E-Mail Address
Phone Number	Fax Number

Yacht Information

Vessel Name	Vessel Type SloopTrawler Ketch Sailing Cruiser Power
Year Built	Length (Feet)
Manufacturer	Hull Material Fiberglass WoodMetal
Motor	Horsepower
Max Speed (MPH)	Fuel Gas Diesel

Hull Value
Market Value	Replacement Value	Purchase Price

Electronic Equipment
VHF	LORAN	RDF	Auto Pilot	DF	Compass	Radar	GPS
Other:

Use of Yacht

Years of Operating Experience	Years You Owned this Boat	Date of Purchase
Used for Waterskiing? Yes No	Used for Racing? YesNo
Where Moored
Navigation Limits
Other Boats Owned (Length, Type, and Years Owned)

Insurance History

Claims in the Last Three Years? NoYes
If Yes, Please Explain and Include Year and Details:
Expiring Insurance Carrier	Expiration Date
Date Last Surveyed	Location AfloatDrydock
How Many Recommendations?	Recommendations Complied With? Yes No
Surveyor

Coverage Desired

Effective Date	Hull Deductible Amount 1% 2% 3%	Hull
P&I	Medical	Tender Value
Outboard Value	Trailer Value	Personal Effects
Other

Please type the word appearing in the box to the right:

For additional information call our Shorepoint yacht specialist (800-350-5647 Ext. 250). We will be happy to answer any of your questions, or contact us.