Insurance Score / Claim History Disclosure
In connection with this application for insurance, we may review your credit report or obtain or use a credit-based insurance score based on the information contained in that credit report. We may use a third party in connection with the development of your insurance score. In connection with this application for insurance, we may review your claims history or loss experience and may report future claims made by you to a claims history provider. 
Applicant agrees to these terms.*
Personal Watercraft Quote Request
When you fill out and submit this form, one of our agents will take your information and provide you a quote within two business days. If you would like an immediate quote, call 1-866-884-6167 Mon - Fri 8 a.m. - 8 p.m ET.

This form allows you to provide information for one boat. If you have two or more boats, we can insure them – just call us!

All fields marked with an asterisk are required. You may find it useful to have your current policyor declarations page handy.
First Name*
Last Name*
If you do not have an email address, please give us a call at 866-880-8651. 
Date of Birth (mm/dd/yyyy):*
Zip Code:*
We apologize that coverage is not available in New York.
How did you hear about us?*
If Agent, who is the agent?
Unit and Coverage
Model Year:*
Current market value (including motor):*
We offer liability only and full coverage policies. Which do you prefer?*
Liability Only
Full Coverage
How much personal liability coverage do you need?*
How long have you owned and operated this boat/PWC?*
Do you want coverage to protect the trailer you use to tow your PWC?
Please tell us the amount of coverage you want for your trailer/tender/dinghy/boat lift.
Is the boat/PWC currently insured? If so, you may qualify for a discount. *
If yes, who is your current insurance company?
Have you had any losses or claims on this boat/PWC in the last three years? *
Please provide the following information so we can contact you with your quote.
We respect your privacy and will never sell or rent your contact information to third parties.
How would you prefer that we contact you?*
Daytime Phone Number
Alternate Phone Number
Best Time to Contact
American Modern may periodically email you news and information related to specialty insurance products.
If you prefer not to receive these communications, please opt-out here.