Boat Quote

Last Name
First Name
M. I.
Address
City
State
Zip
County
Email
Home Phone
Cell Phone
Work Phone
Primary Driver Name
Years of Boating Experience
Navigation Course?		Please Select Yes No
If yes, date completed
Secondary Member in Household that Drives Boat
% of Time Driving Boat
Years of Boating Experience
Navigation Course?		Please Select Yes No
If yes, date completed
List All Others in Household Who Drive the Boat
Present Insurance Company
Renew Date
Boater Organization?
Amount of Boat Insurance
Coverage Type		Please Select Comprehensive Coverage Named Perils
Deductible		Please Select 100 250 500 1,000 1.500 2,000
Territory Use		Please Select Atlantic Coast Great Lakes Inland Waters
Boat Year
Serial Number (last 5 digits only)
Is Boat New or Used?		Please Select New Used
Purchase Price of Boat
Date of Purcahse
Estimated Replacement Cost
Boat Length
Boat Horsepower
Boat Miles per Hour
Boat Manufacturer
Boat Model
Boat Construction		Please Select Wood Fiberglass Other
Boat Type		Please Select House Boat Inboard/Outboard Inboard Outboard Sailboat with Power Sailboat without Power
Diesel Engine?		Please Select Yes No
Motor Amount
Motor Year
Motor Manufacturer
Motor Model
Is Motor New or Used?		Please Select New Used
Purchase Price of Motor
Date of Purchase
Estimated Replacement Cost of Motor
Depth Finder?		Please Select Yes No
Sonar?		Please Select Yes No
Radar?		Please Select Yes No
Ship-to-Shore Radio?		Please Select Yes No
Navigation System?		Please Select Yes No
Burglar Alarm?		Please Select Yes No
Fume Detector?		Please Select Yes No
Built-In Fire Extinguishing System?		Please Select Yes No
Claims in the Last 5 Years		Please Select 0 1 2 3 4 More
Please provide date, amount, and brief description of each incident

Bradley Agency Disclaimer for On-Line Quote By choosing to use this web site (bradleyagency.com) to request an insurance quote, you agree to the following terms and conditions. The materials and information contained in this web site are provided “as is” and without warranty of any kind, either expressed or implied.  The Bradley Agency assumes no liability whatsoever for damages of any kind incurred as a result of your request for a quote or use of this website. Your request for an insurance quote will not bring into effect any insurance coverage.  Insurance coverage may only be effected when your application for insurance is accepted by the Bradley Agency and approved by the carrier as evidenced by the inception date as indicated on a policy. Your entire quote, including the estimated premium and the prospective terms of coverage are tentative and are subject to change without notice based on any and all underwriting criteria, rating dates, manuals, plans and classifications used by Bradley Agency. In the event that there is a difference in the information, rates, premiums or terms contained in a quote and any insurance policy issued to you by the Bradley Agency, the policy governs.