Total Dollar Insurance

Boat Quote

Your Information
Are you currently or were you previously a Total Dollar customer? Yes  No
Name *
Address *
City *
State *
Zip Code *
Phone *  ?
When Would You Like A Call Back? Day  Evening  Anytime
Email *
Occupation: *
Driving Record *
Date of Birth *
Have You Had A Boating Loss In The Last 5 Years? * Yes  No
If so, please describe
Boat & Yacht Information
Year *
Manufacturer: *
Make & Model *
Length *
Hull Material Fiberglass  Wood  Other
Current Hull Value *
Hull Deductible * 1%  2%  3%  Other
Year, Make and HP of Engine(s)
Fuel Type Gas  Diesel  Other
Max Speed
Insurance Coverage Requested
Watercraft Liability $300,000  $500,000  Other
Medical Payments ($2,000 up to $5,000)
Trailer Value
Navigation Area
Navigation Period 8 months  12 months
Mooring or Marina Name
Mooring or Marina Address
Is vessel used commercially? * Yes  No
If vessel is used commercially please describe the operation
Operator Information
Year and Length of Prior Vessels
Years of Boating Experience
Loss Experience Past Five Years
Miscellaneous Information
Currently Insured By
Is Vessel for Sale? Yes  No
Purchase Price of Vessel $
List Safety Gear
* = Required Field
Thank you for providing your information. As a confirmation of your submission, you will receive a copy of the form you submitted in your email. If you don't receive a copy of the submission please contact us at 516-833-1545. We'll be back to you shortly regarding a quote. Total Dollar Insurance Boat & Yacht Department 516-833-1545
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