Boat Insurance Quote from Adams Avenue Insurance Agency

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10 Reasons Why You Should Use Adams Avenue Insurance Agency:

1. The best coverage at the lowest price.

2. Instant phone quotes for most products.

3. Low down payments.

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5. Internet quotes returned within 24 business hours.

6. We have carriers that will insure houses with prior claims and that are in brush areas.

7. Rates are shopped exclusively for you with 25+ auto and home insurance companies.

8. Huge discounts on ALL insurance products!

9. Our experience allows us to match you with the carrier that best meets your needs.

10. We have been saving our customers money on insurance since 1988.

On-Line Boat & Jet Ski Insurance Quote Form One Simple Form - takes only 2-3 Minutes! Your Personal Data
Your Name:
Street Address:
City:
State:	MUST be California!
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):

Marital Status: Single Married	Homeowner? Yes No

Boat Currently Insured? (If yes, list carrier, and # of years continuous. If none, type N/C)

Is this Boat Co-owned? (If yes, list all owners names)

OPERATOR INFORMATION #1

Name: Birthdate:

Sex (M/F): # Years U.S.
Licensing:

Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:

Number & Type of Accidents last 3 years: Number & Type of MINOR Cites last 3 years:

Number & Type of MAJOR Cites last 3 years: Number of Years
Boating Experience:

OPERATOR INFORMATION #2 (if none, leave blank)

Name: Birthdate:

Sex: # Years U.S.
Licensing:

Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations in fields below:

Number & Type of Accidents last 3 years: Number & Type of MINOR Cites last 3 years:

Number & Type of MAJOR Cites last 3 years: Number of Years
Boating Experience:

VESSEL & UNDERWRITING INFORMATION

Year of Boat: Make & Model
(be specific):

Boat Length: Hull Type
(wood, Metal,
fiberglass, etc):

Max. Speed
(in MPH): Market Value: $

Engine Make: Engine Type:
(Inboard, I/O, Jet)

Engine Horse
Power: Fuel Type:
(Gas, Diesel, etc.)

Trailer Cov.
Needed? Yes No Yr./Make/Model
of Trailer:

Trailer Value: $ Where is boat
moored or stored?

Describe waters
boat taken on? Describe boat
general usage?
(fishing, ski, etc.)

VESSEL COVERAGES:

Limits of
Liability: $15/30 BI / 10 PD $25/50 BI / 15 PD
$50/100 BI / 25 PD $100/300 BI / 50 PD

Hull Coverage: NO Coverage $250 Deductible
$500 Deductible $1000 Deductible

Water Ski
Medical Coverage? Yes No Uninsured
Motorists Cov.? Yes No

Comments or Remarks:
(List additional drivers,
special coverages, etc. here)

Send my quotation via: E-Mail Fax
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We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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Adams Avenue Insurance
19895 Beach Blvd., Suite 103
Huntington Beach, CA 92648
Phone: 1-714-593-1914 / Fax: 1-866-832-4186
E-Mail us at: dave@adamsaveins.com