High performance 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

State

Zip code

Marital status

Homeowner?

Boat information

Year

Make

Model

Length (feet)

Weight

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

Date of last Condition and Value survey

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)

Is the boat laid up in the off-season?

Lay up type

Lay up start date

Lay up end date

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

Hull coverage (value of watercraft)

Deductible

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

Medical payments ($1,000 included)

Personal effects ($1,000 included)

Towing ($750 included)

Boat trailer value

Boat house value

Boat lift value

Requested coverage date

Additional comments