RMI Insurance - Boat & Watercraft Insurance

Quote Request

	Auto Insurance
	Boat Insurance
	Motorcycle Insurance
	Home Insurance
	Retirement Planning
	Renters Insurance
	Earthquake Coverage
	& Much More!

Boat & Watercraft Insurance

For a hassle-free, no obligation quote... please take a minute to fill out the form below. Your information will be compared with scores of auto insurance companies for the best quote out there!

Personal Information
First Name:
Last Name:
Garaging Address:
Garaging City
State:
Zip:
Home Phone:
Business Phone:
Fax Phone:
Note: You will not be contacted via telephone unless you indicate this as a preference at the bottom of this form.
Email:

About the Drivers If more than 4 drivers, please provide information in the area provided for comments at the bottom of this page.
Driver 1 Name:
Sex:
Marital Status:
Years of Boating Experience:
Date of Birth:	//
Full Time Student?:
If Student, 3.0 GPA or Higher?:
Have you taken a safety course?:

About the Drivers If more than 4 drivers, please provide information in the area provided for comments at the bottom of this page.
Driver 2 Name:
Sex:
Marital Status:
Years of Boating Experience:
Date of Birth:	//
Full Time Student?:
If Student, 3.0 GPA or Higher?:
Have you taken a safety course?:

About the Drivers If more than 4 drivers, please provide information in the area provided for comments at the bottom of this page.
Driver 3 Name:
Sex:
Marital Status:
Years of Boating Experience:
Date of Birth:	//
Full Time Student?:
If Student, 3.0 GPA or Higher?:
Have you taken a safety course?:

About the Drivers If more than 4 drivers, please provide information in the area provided for comments at the bottom of this page.
Driver 4 Name:
Sex:
Marital Status:
Years of Boating Experience:
Date of Birth:	//
Full Time Student?:
If Student, 3.0 GPA or Higher?:
Have you taken a safety course?:

About the Boats - Boat/Watercraft 1 Please be specific (for example, Year: 1991, Make: Harley Davidson, Model: XLH Sportster 883) For the most accurate quote, please include Vehicle Identification Number (VIN). If more than 4 vehicles, please provide information in the area provided for comments at the bottom of this page.
Year:
VIN:
Make:
Model & Sub Model:
Number of Engines:
Type of Hull:
Vehicle Used Only for Pleasure?:
Current Value?:
Value of Extra Equipment?:

About the Boats - Boat/Watercraft 2 Please be specific (for example, Year: 1991, Make: Harley Davidson, Model: XLH Sportster 883) For the most accurate quote, please include Vehicle Identification Number (VIN). If more than 4 vehicles, please provide information in the area provided for comments at the bottom of this page.
Year:
VIN:
Make:
Model & Sub Model:
Number of Engines:
Type of Hull:
Vehicle Used Only for Pleasure?:
Current Value?:
Value of Extra Equipment?:

About the Boats - Boat/Watercraft 3 Please be specific (for example, Year: 1991, Make: Harley Davidson, Model: XLH Sportster 883) For the most accurate quote, please include Vehicle Identification Number (VIN). If more than 4 vehicles, please provide information in the area provided for comments at the bottom of this page.
Year:
VIN:
Make:
Model & Sub Model:
Number of Engines:
Type of Hull:
Vehicle Used Only for Pleasure?:
Current Value?:
Value of Extra Equipment?:

About the Boats - Boat/Watercraft 4 Please be specific (for example, Year: 1991, Make: Harley Davidson, Model: XLH Sportster 883) For the most accurate quote, please include Vehicle Identification Number (VIN). If more than 4 vehicles, please provide information in the area provided for comments at the bottom of this page.
Year:
VIN:
Make:
Model & Sub Model:
Number of Engines:
Type of Hull:
Vehicle Used Only for Pleasure?:
Current Value?:
Value of Extra Equipment?:

Driving History - Driver 1 Please provide accurate information for: last 3 years (Minors - speeding, etc.) last 5 years (Majors - drunk driving, reckless, hit & run, etc.)
No. of Minor Violations:
Dates
No. of Major Violations:
Dates
No. of Accidents (Not At Fault):
Dates
No. of Accidents (At Fault w/o Bodily Injury):
Dates
No. of Accidents (At Fault with Bodily Injury):
Dates
Driving History - Driver 2
No. of Minor Violations:
Dates
No. of Major Violations:
Dates
No. of Accidents (Not At Fault):
Dates
No. of Accidents (At Fault w/o Bodily Injury):
Dates
No. of Accidents (At Fault with Bodily Injury):
Dates
Driving History - Driver 3
No. of Minor Violations:
Dates
No. of Major Violations:
Dates
No. of Accidents (Not At Fault):
Dates
No. of Accidents (At Fault w/o Bodily Injury):
Dates
No. of Accidents (At Fault with Bodily Injury):
Dates
Driving History - Driver 4
No. of Minor Violations:
Dates
No. of Major Violations:
Dates
No. of Accidents (Not At Fault):
Dates
No. of Accidents (At Fault w/o Bodily Injury):
Dates
No. of Accidents (At Fault with Bodily Injury):
Dates

Limits of Liability
Bodily Injury:
Property Damage:
Uninsured Motorist/Bodily Injury:
Uninsured Motorist Property Damage Waiver:
Medical Payments:

Deductibles
Vehicle 1
Do you want Physical Damage coverage?
Comprehensive:
Collision:
Vehicle 2
Do you want Physical Damage coverage?
Comprehensive:
Collision:
Vehicle 3
Do you want Physical Damage coverage?
Comprehensive:
Collision:
Vehicle 4
Do you want Physical Damage coverage?
Comprehensive:
Collision:

Additional Endorsements & Misc. Information
Towing & Roadside Service:
Rental Car Reimbursement:
SR-22 Filing Needed:
Do you currently carry Liability coverage?:
If so, how long insured without a lapse in coverage?:	Years Months
Name of Current Insurance Company:	(optional)
Expiration Date of Current Policy:	(optional)
Current Premium:	(optional)
Would you like to be contacted via telephone?:
Would you like to be contacted via fax?:
Association Name?:
Alarm?:
Questions, Comments or Additional Information:
How Did You Hear About Us?:

Please verify your information before submitting.