Anchor Insurance, Inc. - insurance, commercial auto, truck, fleet, business insurance

Anchor insurance, Inc.
30 Tremont Street • Duxbury, MA 02332
781-934-7114 local • 800-649-3000 toll free in MA. • 781-934-2717 fax

Marine/Boat Insurance Quotes
We provide insurance coverage in Massachusetts only.
Sorry, other states not available.

1. Full Name

2. Address

3. City
State
Zip

4. Email

5. Home Phone

6. Work Phone / Ext.:

7. OK to Call At Work? Yes No

8. Fax

9. Best Time To Contact

General Information

10. Type Of Hull

11. Hull Design

12. Hull Material

13. Type of Power

14. Year (ie. 1996)

15. Manufacturer/Model

16. Length

17. Max. Speed

18. Date Purchased (ie. 1996)

19. Cost New $

20. Present Value $

21. Waters Navigated

22. Berth Storage Location

23. Lay Up Period (list dry and afloat times)

Engine/Outboard Motor

24. Year (i.e. 1996)

25. Manufacturer/Model

26. Horsepower (MPH)

27. Fuel

28. Cost New $

29. Present Value $

Trailer Optional Coverage

30. Manufacturer/Model

31. Year Made

32. Cost New $

33. Present Value $

Coverage's/Limits of Liability

34. Hull

35. Outboard Motor (optional if not included in hull value)

36. Portable Accessories (state value)

37. Liability Coverage's

38. Equipment (check Yes or No)

Bilge Pumps Yes No

Cooking Stove Yes No

Fume Detector Yes No

CO2/Chemical System Yes No

Fire Extinguishers Yes No

Depth Sounder Yes No

Radar Yes No

Radio Direction Finder Yes No

Ship To Shore Radio Yes No

Anti Theft Devices Yes No

Heating Yes No

39. Operators (list all residents and dependents (licensed or not) and regular operators

Name Date of Birth Drivers License# Experience

1.

2.

3.

4.

40. General Information (check Yes or No to all)

Is the boat chartered to others? Yes No

Is the boat used commercially or for business purposes? Yes No

Is the boat used for racing? Yes No

Is the boat used for water-skiing? Yes No

Does the applicant employ a paid crew? Yes No

Has the applicant lived at the current address less than 3 years? Yes No

Any operator have physical/mental impairments? Yes No

Any drivers license suspended during last 3 years? Yes No

Any operator have accident/conviction during the last 3 years? Yes No

Any losses occurred during the last 3 years? Yes No

Any coverage declined, canceled, or non-renewed during the last 5 years? Yes No

Any sleeping facilities? Yes No

If Yes, how many beds?

41. Questions and/or Comments

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Important Note: Quotes will be based on the information provided. It is only a rate calculation and is not binding in any way. A full application must be completed and signed by the named insured.

38. Equipment (check Yes or No)
Bilge Pumps	Yes No
Cooking Stove	Yes No
Fume Detector	Yes No
CO2/Chemical System	Yes No
Fire Extinguishers	Yes No
Depth Sounder	Yes No
Radar	Yes No
Radio Direction Finder	Yes No
Ship To Shore Radio	Yes No
Anti Theft Devices	Yes No
Heating	Yes No

40. General Information (check Yes or No to all)
Is the boat chartered to others?	Yes No
Is the boat used commercially or for business purposes?	Yes No
Is the boat used for racing?	Yes No
Is the boat used for water-skiing?	Yes No
Does the applicant employ a paid crew?	Yes No
Has the applicant lived at the current address less than 3 years?	Yes No
Any operator have physical/mental impairments?	Yes No
Any drivers license suspended during last 3 years?	Yes No
Any operator have accident/conviction during the last 3 years?	Yes No
Any losses occurred during the last 3 years?	Yes No
Any coverage declined, canceled, or non-renewed during the last 5 years?	Yes No
Any sleeping facilities?	Yes No
If Yes, how many beds?