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Online Service Center Jump to a different form... Automobile Quote Homeowners Quote Life Insurance Quote Watercraft Quote Motorcycle Quote Other Quote Automobile Change Homeowners Change Other Change Automobile Claim Homeowners Claim Other Claim Auto ID Cards Certificates Billing Inquiry Contact Us Back to Service Center page Watercraft Quote Request Please note: We cannot bind coverage from an email request. Coverage is bound after you receive a written email or telephone confirmation from an agency staff member. Effective Date: Your Name: Your Mailing Address: Street City, State, Zip       E-mail Address: Daytime Phone #: Choose One: Please call me with quote premium. Please send quote via e-mail. Description of Property: Motor type: Outboard Inboard Outdrive Water jet Number of Engines: Twin Single None Boat Type: Sail Power Other Other Boat Type Fuel: Gas Diesel None Maximum Speed: Hull Material: Fiberglass Steel Wood Aluminum Other Other Hull Material: Insured Watercraft: Boat:        Year Manufacturer Model  Serial Number Total HP Length                 Outboard Motor:   Year Manufacturer Model Serial Number  Total HP                     Trailer:    Year Manufacturer Serial Number                               Coverages:   Limits: Boat (Including Auxiliary Equipment) Outboard Motor 1 Outboard Motor 2 Boat Trailer Personal Property Commercial Towing Boat Liability $300,000 $500,000 $1,000,000 Medical Payments Automatic only $Limit 1 $Limit 2 $Limit 3 Uninsured Boater Optional Coverages Agreed Value Endorsement Actual Cash Value Fishing Equipment - Limit:   Safety Equipment: Check all that apply: GPS Automatic CO2 (Halon) Ship to Shore Radio (VHF) Depth Sounder Electronic Burglar Alarm Radar Plotter EPIRB Vapor Detector Alarm Operator Information: Date of Birth: Years of Boating Experience: Waters to be Navigated: Inland waters of the following states: Coastal waters of the following states: Is the boat chartered or used for other than private pleasure purposes? Yes     No Previous Loss Information Please describe any losses or claims filed on your Boat Insurance in the last 3 years. Please include the date and type of the loss, as well as the amount of the claim Additional Comments Please use the box below to enter any additional information you wish to include:          If you have not received a response from us within one business day, please contact us again. Thank you.   Executive Insurance Group  7225 Sunset Strip NW North Canton, OH 44720 330-966-0080 800-981-0080 Toll-Free 330-966-1522 Fax info@executiveinsurance.com Copyright © Executive Insurance Group, 2008