IMPORTANT NOTICE

1. This boat insurance quote request applies only to the states of Oregon and Washington. Do not fill out this form if you do not live in Oregon or Washington.

2. No insurance will be started by submitting this form. Coverage may be placed in force only after you decide to purchase it from us, and then after you complete and sign the boat insurance application and pay the initial premium.

3. Submitting the following quote request constitutes your agreement with the above statements. We will contact you within two business days after we receive your request. If you have questions concerning this notice or about the following form, please call us at 503-620-0230 or toll-free 1-888-620-0230.

Boat Insurance Quote Request
  1. Your first name
    Invalid Input
  2. Middle name
    Invalid Input
  3. Last name
    Invalid Input
  4. Home phone number
    Invalid Input
  5. Other Phone Number
    Invalid Input
  6. Email address
    Invalid Input
  7. Fax number
    Invalid Input
  8. Street address
    Invalid Input
  9. City
    Invalid Input
  10. State
    Invalid Input
  11. Zip code
    Invalid Input
  12. Have you moved in the last 60 days?
    Invalid Input
  13. Boat Year
    Invalid Input
  14. Boat Make
    Invalid Input
  15. Boat Model
    Invalid Input
  16. Hull Material
    Invalid Input
  17. Boat Length in feet
    Invalid Input
  18. Number of motors
    Invalid Input
  19. Total Horsepower
    Invalid Input
  20. Propulsion Type
    Invalid Input
  21. Does the boat have an exposed engine?
    Invalid Input
  22. Is it modified for enhanced performance?
    Invalid Input
  23. Maximum Speed
    Invalid Input
  24. Value of boat including motors
    Invalid Input
  25. Value of trailer
    Invalid Input
  26. Storage or mooring zip code
    Invalid Input
  27. Watercraft Use
    Invalid Input
  28. If there are any additional watercraft, list details here.
    Invalid Input
  29. Are you the original owner?
    Invalid Input
  30. Names of additional owners
    Invalid Input
  31. Driver First Name
    Invalid Input
  32. Middle Name
    Invalid Input
  33. Last Name
    Invalid Input
  34. Date of birth
    Invalid Input
  35. Social security number
    Invalid Input
  36. Gender
    Invalid Input
  37. Marital Status
    Invalid Input
  38. Drivers License Number
    Invalid Input
  39. Drivers License Status
    Invalid Input
  40. Relationship
    Invalid Input
  41. Have you completed a safety course?
    Invalid Input
  42. Enter all claims, accidents and traffic violations for the last 36 months
    Invalid Input
  43. Do you have at least 6 months continuous insurance during the last 12 months?
    Invalid Input
  44. Prior Boat Insurance Company
    Invalid Input
  45. Prior Term Expiration Date
    Invalid Input
  46. If there are any additional drivers, list details here.
    Invalid Input
  47. Additional information or comments
    Invalid Input
  48. Re-type the security field numbers in the box.
  49. Security Field
    Security Field The Security code you typed did not match. Please click "Refresh" and try again.
  50. To keep a copy of this form, please Print before Submitting
  51.   

 

Network with BTIA

Follow us on Twitter & Facebook:
BTIA on Facebook  BTIA on Twitter
Share this page with your network:
AddThis Social Bookmark Button

Questions?

If you have questions concerning this information, please call us at 503-620-0230, or come in.

Llámenos ya al 503-620-0230.