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CoverMyYacht.com / Boat Insurance Application


----------- Personal Information -----------

** Required Fields
** E-Mail 
 
** Full Name  
 
** Telephone  
 
Fax
Address
 
City
 
State
 
Zip Code  
 

----------- Boat Information -----------

Please complete as much information as possible
Years of boating experience:
 
Vessels Length and Makes:
 
Active Boating safety course or License w/Certificate:

 
Any claims?:

 
Navigational Area:
 
If yes what happened?:
Date / accident / claim $
 
Year, Make, Model & Length of Boat:
 
Primary Storage Location:
Include Address Zip and storage type
 
Is it used as a full time residence - Used as Live Aboard?:

 
Date purchased?:
 
Value of your boat:
 
Engine year: :
 
HP:
 
# of motors:
 
Engine Make:
 
Type:
 
Fuel Type:
 
Trailer Year:
 
Value:
 
Trailer Make:
 
Liability Limits and Coverage Requested:
 
Type of use?:


 
Additional Notes:
 
 

Please note: All submissions and quotes are non-binding.



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The Atlass Insurance Group
A Risk Strategies Company
1300 S.E. 17th St., Suite 220
Fort Lauderdale, FL 33316
The Atlass Insurance Group
Small Boat & Personal Watercraft Insurance
Quote Line +1 800.330.3370