Mariners General Insurance Group

Quote Request

For information about how Mariners General Insurance Group can help you with your marine insurance needs, please complete the information on the form below and submit. We will prepare and return a quote to you via e-mail or fax within 48 hours. For immediate assistance, call us at (800) 992-4443.

First Name	*
Middle Name
Last Name	*
DOB	/ / (as 01/01/1901) *
Address 1	*
Address 2
City	*
State	*
Zip	*
Phone	- - *
Fax	- -
E-Mail	*
Occupation
Years Boating Experience	*
If applicable, list all previous vessels owned (Name & Length)
Vessel Purchase Date	/ / *
Vessel Name
Year Built	*
Length	*
Type	*
Maximum Speed	*
Boat Manufacturer	*
Mast Material
Hull Material	*
Number of Engines	*
Engine HP (Each)	*
Engine Manufacturer
Engine Type/Fuel	*
Auto Extinguish System	*
Paid Crew
Primary Moorage Location	Marina: Address: City: State: Zip: (City, State, Marina) *
Date Last Surveyed	/ /
Market Value	*
Purchase Price	*
Survey
Charter Use?	*
If so, average time (days)
Average # of passengers
Desired Navigational Territory
Other - Please Specify
Requested Hull Coverage	(Market Value) *
Hull Deductible
Personal Effects
P&I Liability
Other - Please Specify
Dinghy & Outboard	* If none, please type none
How did You hear about us
If applicable, please fill out the additional information below:
Current Insurance Company
Annual Premium	$
Policy Expiration Date	/ /
Any marine insurance lost in the last 5 years
If yes, specify the date and amount paid by your insurance company
Additional comments or questions:
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