NEBRASKA CITY, NE
ROCK PORT, MO
AUBURN, NE

Phone: 
Toll Free: 
Fax: 

(402) 873-3344
(800) 562-7083
(402) 873-3506

 

 
 
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Watercraft Insurance Quote

For a fast comparison of your current insurance, just fax us a copy of your policy declaration pages. 402-873-3506
 

Date:
Name:
Email
Address:
City:
State: Iowa
Kansas
Nebraska
Missouri
*Quotes only available for Iowa, Kansas, Nebraska, and Missouri.
Zip:
Phone:
Fax:
 
WATERCRAFT  INFORMATION
Type: Boat
JetSki
Other
Year:
Make & Model:
Hull Construction: Fiberglass
Metal
Length:
Other Information:
 
MOTOR  INFORMATION (as applicable)
Type: Inboard
Outboard
Year:
Make & Model:
Horsepower:
Max Speed:
Other Information:
 
TRAILER INFORMATION (as applicable)
Year:
Make & Model:
Other Information:
 
OPERATOR INFORMATION
All operators 3+ years boating experience? No Yes
Enter dates and descriptions of any auto Accidents or Violations that have 
occurred over the last 3 years for all operators.
 
POLICY INFORMATION
Liability Limits: 100,000 Combined SL
300,000 Combined SL
500,000 Combined SL
Medical Pay: $1000 $2000 $5000
Comprehensive Deductible: $100 $250 $500
Collision Deductible: $100 $250 $500
 
Watercraft Value: $
Outboard Motor Value: $
Trailer Value: $
 
Repair Cost Option: No Yes
Other Information:
 
Discounts (check all that apply)
Marine Course Completed:
Supporting Auto Ins:
Automatic fire extinguishing system:
Burglar Alarm System
VHF ship-to-shore radio: 
Depth finder: 
Fume Detector: 
Self-bailing Mechanism: 
Marine Compass: 
 
Questions or Comments

Thank you for taking the time to fill out this request.
We will have a quote returned to you by email as soon as possible.
If you have any questions concerning insurance quotes,
please give us a call at 402-873-3344 

 
 




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