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First Name

Last Name

Phone

Example: 123-456-7890 or 1234567890

Street Address

City

State

Zip Code

Example: 12345

Date of Birth (MM/DD/YYYY)

Marital Status

Homeownership

Years of Boat Ownership

If yes, what is the make, model, and length of the most recent vessel you have owned or operated?

Have you had any boating accidents of boating insurance claims in the last 5 years?

If yes, please explain

Are you an America's Boating Club Member?

Manufacturer

Model

Year

Length

Purchase Year

Purchase Price

Does purchase price include trailer?

Previously untitled?

Engine Type

Fuel Type

Number of Engines

Total HP of Engine(s)

Mooring Address or Marina Name

Mooring Zip Code

Example: 12345

What will be the primary use for this vessel?

Agent or Dealer Business Name (Optional)

Agent or Dealer Contact Name (Optional)

Agent or Dealer City (Optional)

Agent or Dealer State (Optional)

Agent or Dealer Zip Code (Optional)

Agent or Dealer Phone (Optional)

Example: 123-456-7890 or 1234567890

Agent or Dealer Email (Optional)

Hull and Machinery Value

Trailer Value (Optional)

Dinghy/Tender Value (Optional)

Liability Limit (Optional)

Deductible

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McGriff Recreational Specialty: 800-937-8895
Hours of Operation: 8:00 a.m. – 4:45 p.m. Central Time Monday-Friday

Insurance products and services offered through McGriff Insurance Services, LLC, a subsidiary of Truist Insurance Holdings, Inc., are not a deposit, not FDIC insured, not guaranteed by a bank, not insured by any federal government agency and may go down in value.

McGriff Insurance Services, LLC. CA License #0C64544

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