Island Marine Center Insurance Quote Application
START HERE - How would you like to begin?
Option 1 - Fill out and submit the secure insurance application below.
Option 2 - Download and print the insurance application and mail it to us. – Coming Soon!
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Option 3 - Request an insurance application package by email.
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* = required field.
Step 1 - Personal Information
First Name: *

Last Name: *

Address:


City: *
State: *
 Zip Code: *


Home Phone:

Work Phone:

Fax:

Cell Phone:

Date of Birth (mm/dd/yyyy): *

Email Address: *
Step 2 - Boat Information
Vessel Year: *

Vessel Length (Feet): *

Vessel Manufacturer: *

Vessel Model: *

Hull Material:

Max Speed:

Vessel Purchase Date: *
Number of Engines: *

Engine Manufacturer:

Horsepower (each): *

Boat/Motor Value:

Fuel Type:

Drive: *


Include Trailer in Policy:
Yes No

Trailer Purchase Price:
Mooring Location City: *


Mooring State: *

Marina:
 Boating Courses Completed:
USCG
USPS
ASA
Cap Lisc
Years of General Boating Experience: *
List Previous Boats Owned (Size and Make): *

Previous Insurance Claims on Boats: *

Describe Claims:

Driving Record (Tickets, Accidents, DUI's for 5 yrs.): *

Step 3 - Coverages Requested
Deductible: *

Hull & Equipment Aged Value ($0,000): *

P&L Liability ($0,000): *

Trailer/($0,000): *


 Medical Payments ($0,000): *

Uninsured Boater ($0,000): *

Personal Effects ($0,000): *

Towing Coverage ($0,000): *