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.*
 
  
 
   
Yacht 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*    
 
Email*    
 
If you do not have an email address, please give us a call at 866-880-8651. 
 
   
Date of Birth (mm/dd/yyyy):*    
 
Address*    
 
City*    
 
State*    
 
Zip Code:*    
 
We apologize that coverage is not available in New York.
 
   
How did you hear about us?*
 
  
If Agent, who is the agent?    
 
 
   
Boat Information    
 
   
Model Year:*    
 
Boat Type*
 
  
Length (in feet):*    
 
Manufacturer*    
 
Model:*    
 
Horsepower*    
 
Maximum Speed:    
 
Current market value (including motor):  
 
 
What is the weight of your boat (in pounds)?  
 
 
What type of engine powers your boat?*  
 
 
Number of Engines:
 
  
If the boat is moored, please provide the Zip Code of its location
 
  
 
   
Coverages and Limits    
 
   
We offer liability only and full coverage policies. Which do you prefer?*
Liability Only
Full Coverage
 
  
 
   
Select your desired amount of liability coverage*
 
  
Please tell us the amount of coverage you want for your trailer/tender/dinghy/boat lift.
 
  
Do you have experience operating boats?
Yes
No
 
  
If yes, how many years of boating experience do you have?
 
  
Is the boat/PWC currently insured? If so, you may qualify for a discount. *
Yes
No
 
  
Do you insure your boat with a standalone policy, or endorse your boat onto home insurance policy?
 
  
If yes, who is your current insurance company?
 
  
Full coverage policies can also protect boat trailers. If you need coverage for these on your policy
Yes
No
 
  
Full coverage policies can also protect boat lifts. If you need coverage, select here:
Yes
No
 
  
Full coverage policies can also protect tenders/dinghies. If you need coverage select here:
Yes
No
 
  
Have you had any losses or claims on this boat/PWC in the last three years? *
Yes
No
 
  
Have you been involved in any water-related violations in the last three years?*
Yes
No
 
  
In the last three years, have you had any minor or major moving violations that are not watercraft *
Yes
No
 
  
 
   
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.
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