Boat Insurance Quote Requests

Please fill out the form below to send us a Boat Insurance Quote Request. The form is sent to us instantly via email.

First Name:		Last Name:
Address:
State:		Postcode:
Phone:	Private: Business: Mobile:
Email:
Wide Bay Australia Client Number:
Best Time to Call:
Where is the boat stored?	State: Postcode: Suburb:
Boat Make:		Construction type:
Year of Construction:		Motor make:
Motor:	Single Twin	Petrol Diesel
Turbo Charged:	Yes No	Mount: Mid Rear
Maximum speed of boat	km/hr	Is the boat used for racing? Yes No
Type of Fire Extinguisher onboard		Do you require Waterskiers’ Liability? Yes No
Does the boat have any non-standard special modifications?		Yes No (if yes, write details in Comments section below)
Market value of boat	$	Purchase price: $
Claims
Have you or any other owner of the boat suffered any at-fault claims in the last 5 years?			Yes No
No. of claims in
2006: 2005: 2004: 2003: 2002:
Payments: Annual Monthly
Questions/Comments/Requests:

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