StevensMarineLogo_FINALV3Request a Quote

Date of Birth (required)
[date DOB* "Date of Birth"]

Phone Number (required)
[tel tel-home* "homephone"]

Home Address (required)

City (required)

Zip Code (required)

State (required)

Social Security # (no dash's)

Motor Vehicle Accident in the past 3 years
YesNo

If yes, please describe below

Years of experience as owner (required)

Years of experience as crew (required)

Types of boats owned and operated (required)

Formal Coarse
USCGUS Power SquadronUSCG License CaptainOther

Have you had a watercraft losses or claims in the past 5 years?

If yes, please describe below

Year of Boat (required)

Manufacturer (required)

Model (required)

Length (in feet) (required)

Construction (required)
[select menu-construction* "" "Carbon Fiber" "Fiber Glass" "Steel " "Wood" "Other"]

If other, please explain

Type

Engine Type (required)

Number of Engines (required)

Total Horsepower (required)

Fuel
DieselGasolineElectricPropaneNone

Top Speed

Fume Detector
YesNo

Automatic Fire Detector
YesNo

Navigational Equipment
CompassDepth SounderGPSRadarVHF Radio

Date of Survey, if available

Water-Skiing
YesNo

Year of Trailer

Manufacturer of Trailer

Value

Year of Tender

Engine Manufacturer

Use
Private PleasureCharter

If Charter, please describe

Date Normally Launched

Date Normally Hauled

Where stored in the summer? (required)

Where stored in the winter?

Navigation Limits (required)
Atlantic CoastGreat LakesGulf of MexicoInland LakesOther

If other, please explain

Amount of Insurance on Hull & Machinery ($) (required)

Deductible

If other, please list deductible

Fishing Equipment Value ($)

Amount of Insurance on Trailer ($)

Watercraft Liability (required)

Medical Payment

If other, please list medical payment

Current Insurance Company

Expiration Date

Current Premium

Vanner Insurance Agency
11 Pinchot Court, Suite 100
Amherst, New York 14228

Phone: 716.688.8888

Email: info@vannerinsurance.com