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PWC / Boat Quote
This information is optional, however
providing your SS# will produce the most
accurate quote.
Marital Status
Single
Married
Do you have a valid Texas Driver's License?
_______________________________________________________________________
Garaging Address (If different from above)
_______________________________________________________________________
Driving History
Number of ( At Fault) Accidents in the past 36 months
Number of ( Not At Fault) Accidents in the past 36 months
Number of Tickets in the past 36 months
Number of years boating experience
_______________________________________________________________________
Boat or PWC Details
Boat or PWC #1
Boat or PWC #2
Outboard Motor
Trailer
Is there a Lienholder ?
_______________________________________________________________________
Coverage Details
What are the coverages you would like quoted to you?
Liability Only
Liability and Comprehensive (Includes Theft)
Liability and Comprehensive + Collision
Optional Coverages you may want quoted to you
?
Uninsured Boaters
Medical Payments
Watercraft Coverage Questions
Fishing Equipment Coverage
Replacement of Personal Effects Coverage
On-Water Towing
How would you like us to respond to this quote request?
E-mail
Phone
 Both
B.P. Cummings

                  Insurance Agency

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Watercraft Coverage Questions