Riemenschneider Insurance Agency, LLC

Watercraft Insurance Quote

When you submit your information for a quote, we will find the best possible rate amongst all of our nationally recognized business partners. We do everything we can to provide the best possible prices to our customers.

To ensure a reliable quote, please complete the selected form as accurately as possible. Should you have any questions, feel free to contact us via phone at (215) 855-4995.

Disclaimer: These forms are not an official application for insurance and submitting your information does not obligate this agency to issue any policy of insurance.

Name: Address: City: State: Zip Code: Phone: eMail: Date of Birth:

Insured Information

Current Insurance Company: Requested Effective or Renewal Date:

Lender Information

Mailing Address: Mailing Address (line 2): City: State: Zip:

Owner/Operator Resume

Years of Experience: Courses Completed USPSUSCG Other: Prior Boats Owned: Driver’s License #: License State: Owner’s Occupation: Date of Birth: Name of Paid Crew: Other Operators: Previous Losses: Previous Insurance:

Hull

Hull Deductible: Year (00): Length (ft.): Manufacturer: $ Value of Craft: Type: Name of Vessel: ID Number:

Trailer

Trailer Deductible: Year (00): Manufacturer: $ Value of Trailer: ID Number:

Engine

Fuel Type: Year (00): Manufacturer: Horespower: $ Value: ID Number:

Engine 2

Fuel Type: Year (00): Manufacturer: Horespower: $ Value: ID Number:

Dinghy / Engine

Dinghy Engine Deductible: Year (00): Manufacturer: Horespower: $ Value: ID Number:

Deductible

Protection & Indemnity / Liability: Medical Payments:

General Information

Storage/Mooring Location: Zip Code: Purchase Price: Date of Purchase: Slip #: Lay Up Period (start): Lay Up Period (end):

Additional Information

Hull Material: Date of Last Survey: Surveyor: Date Last Hauled: Yard Bills Attached? Is Boat used Commercially? Live Onboard? Equipment Ship to StoreVHFRDFFume DetectorRadarLoran/GPSDepth SounderSat NavAuto PilotAuto Halon Other: Additional Comments (optional):

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About Us

We have been in the insurance business since 1983 and have developed strong relationships with many nationally recognized companies.

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642 E Main St Lansdale, PA

info@riemenschneiderinsurance.com

(215) 855-4995

10 AM – 5 PM