Small boat insurance application

Burns & Wilcox Powersports Service Center +1.855.480.9763
Monday – Friday, 7:00 a.m. – 8:00 p.m. CST

Please note: There is no option to save the form, so please have all information ready when you begin. Detailed information about the boat and boating experience is required.

Fields with an asterisk (*) are required.

Agent information

Your full name

Phone number

Email address

Agency name, address, city, state, and zip code

Owner information

Multiple owners

Corporation or trust

Owner's full name

Date of birth

Residence address

City

Zip code

State

Marital status

Homeowner?

Boat information

Year

Make

Model

Length (feet)

Hull type

Hull material

Max. speed (mph)

Number of engines

Total horsepower

Propulsion/Drive type

Fuel type

Is this vessel being used commercially?

Purchase year

Purchase price

Boat navigation

Where is the boat used? (please provide specific bodies of water)

Offshore navigation distance

Boat storage information

In-season storage location (address, city, state, and zip code)

Operator information

List all operators (primary operator first). Include name and date of birth.

Operated experience: For each operator, include previously operated watercrafts, length, and # of years operated.

Owned experience: For each operator, include previously owned watercrafts, length, and # of years owned.

List all marine losses and all motor vehicle violations and accidents for each operator. Include date, amount of loss, and description. If no prior losses, please list NONE.

Coverage and limits

Watercraft and equipment value

Boat trailer value

Liability (will include uninsured boater and highest available pollution limit)

Medical payments ($1,000 included)

Personal effects ($1,000 included)

Towing ($500 included)

Fishing equipment

Boat lift

Requested coverage date

Additional comments