"*" indicates required fields

Tell us about yourself

Primary Contact Name*

First Last

Business Name

(if Insured is a Company, Corporation, Trust, or LLC)

Insured's Occupation

Mailing Address*

Street Address Line 1 Street Line 2 City State / Province / Region ZIP / Postal Code Country

Watercraft Information

Is the watercraft titled in the name of a company or corporation?*

Yes

Name of Business*

Name of Vessel*

Type of Boat*

Year*

Manufacturer*

Model*

Hull ID No.*

Length in ft.*

Hull Material*

Propulsion Type*

Fuel Tank Type*

Number of Engines*

Year of Engine*

Make of Engine*

Horsepower per Engine*

Max Speed*

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Total Horsepower

Equipment*

Check all that apply. Select None if no equipment.

Bilge Pumps

Cooking Stove

Flame Detector

CO2/Halon System

Fire Extinguishers

Anti-Theft Devices

Depth Sounder

Radar

Loran/Direction Finder

Ship to Shore Radio

SATNAV/Omega

Aux Generator - Gas

Aux Generator - Diesel

EPIRB

Engine Alarm

Life Raft

Sonar

GPS

None

Other

Other Equipment*

Purchase Price*

Current Value (not including trailer)*

Purchase Date*

Month

Day

Year

Do this boat have a trailer?*

Yes

Value of the trailer?*

Have you had a survey on your watercraft in the past 3 years?

Yes

Date of last survey

MM slash DD slash YYYY

Survey was conducted*

In Water

Ashore

A SURVEY WILL BE REQUIRED. Liability only policies will need an In Water Survey. To include Hull Coverage, an Out of Water Survey will be required. To find a local survey visit the Society of Accredited Marine Surveyors.

Waters to be navigated in the next 12 months

Advise vessel location or itinerary July 1 to November 1

Mooring and Usage

How is the watercraft stored?*

Name of Marina / Storage Facility*

Is the mooring/storage address the same as your mailing address?

Yes

Mooring Address

Street Address Address Line 2 City State ZIP Code

Where is the vessel typically used?*

Gulf Coast

East Coast (North of Florida)

Florida

West Coast

Bahamas

Caribbean

Other

Other location typically used

How do you use your watercraft?*

Select all that apply

Pleasure Use

Charter Operations

Liveaboard / Primary Residence

Business/Commercial Use

Racing/Speed Contests - Sail only

Engine/Outboard Motor Information

Engine(s) Information

For main vessel only

Fuel

Year Built/Overhaul

Manufacturer & Model

Serial #

Date Purchased

Purchase Price

Tender/Dinghy Information

Is there any tender or dinghy?

Yes

Tender / Dinghy Information

Year

Engine Make/Model

HID

Reg #

Tender/Dinghy anit-theft precautions*

Operator 1

Name

First Last

Date of Birth*

Month

Day

Year

Auto Drivers License #*

Auto Drivers License State

Prior Boating Experience

Has Operator 1 owned any prior boats before?

Yes

Details of previous vessels owned

Include length/make details of boat, number of years owned, any boating qualifications, and USCG or other certificate.

Details of previous vessels owned (Line 2)

Any violations/suspensions (including automobile) in the last 5 years

Yes

Years of Total Boating Experience*

Boater Training Completed*

Add Second Driver

Yes

Operator 2

Driver 2: Name*

First Name Last Name

Driver 2: Date of Birth*

Month

Day

Year

Driver 2: Auto Drivers License #*

Driver 2: Auto Drivers License State

Driver 2: Any violations/suspensions (including automobile) in the last 5 years

Yes

Driver 2: Years of Boating Experience*

Driver 2: Boater Training Completed*

Add Third Driver

Yes

Operator 3

Driver 3: Name*

First Name Last Name

Driver 3: Date of Birth*

Month

Day

Year

Driver 3: Auto Drivers License #*

Driver 3: Auto Drivers License State

Driver 3: Any violations/suspensions (including automobile) in the last 5 years

Yes

Driver 3: Years of Boating Experience*

Driver 3: Boater Training Completed*

General Information

Is boat chartered to others with captain?

Yes

Is boat chartered to others without captain?

Yes

Will the boat used for racing?

Yes

Is the boat used for water skiing or diving?

Yes

Is the boat used for fare-paying passenger charters?

Yes

Average passengers per trip

Maximum passengers per trip

Number of charter trips per year

Is the boat used commercially or for business purposes?

Yes

Will the vessel be operated single handed at night?

Yes

Was any operator involved in a marine loss in the last 10 years?

Yes

Does the applicant employ a paid crew?

Yes

Is this a year-round liveaboard vessel or is the vessel used as a residence 12 months?

Yes

Coverage Options

If you are unsure about these coverage limits, skip this section. Your agent will talk to you about recommending the proper coverage limits needed.

Hull Physical Damage Amount

Tender/Dinghy Amount

Liability Amount or Watercraft Liability Amount

Crew Liability Amount

Commercial Passenger Coverage

Medical Payments Coverage

Personal Property Coverage

Uninsured Boaters Coverage

Trailer Coverage Amount

Non-Emergency Towing Coverage

Other Coverage

Final Questions

Have you had any boat insurance losses in the past 5 years?*

Yes

Please describe the loss (what happened, when, how much was paid)

Was any coverage declined, cancelled, or non-renewed in the last 5 years?*

Yes

Is your watercraft currently insured?*

Yes

Name of current insurance carrier*

Additional Named Insured(s) - If any

Comments or Questions

File Attachment(s)

Drop files here or

Accepted file types: pdf, jpg, Max. file size: 12 MB, Max. files: 5.

Contact Information

Email*

Phone*

SMS Consent

By checking this box, you consent to receive text messages from Eton Bridge Insurance and Financial Solutions at the mobile number provided regarding your insurance inquiries, quotes, and policy updates. Consent is not a condition of purchase. Message and data rates may apply. Message frequency varies. Reply HELP for help or STOP to cancel. View our Privacy Policy and Terms of Service

How did you hear about us?

Date you want this policy to start*

MM slash DD slash YYYY

Phone

This field is for validation purposes and should be left unchanged.

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Tell us about yourself

Watercraft Information

A SURVEY WILL BE REQUIRED. Liability only policies will need an In Water Survey. To include Hull Coverage, an Out of Water Survey will be required. To find a local survey visit the Society of Accredited Marine Surveyors.

Mooring and Usage

Engine/Outboard Motor Information

Tender/Dinghy Information

Operator 1

Prior Boating Experience

Operator 2

Operator 3

General Information

Coverage Options

Final Questions

Contact Information

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