Please enter your information into the fields below. Your information will then be submitted electronically to our office. An agent will be in touch with your quote within 24 hours. If you need to talk directly to an agent please call 480-357-9663. You may also email us at: s.shute@wakezoneinsurance.com Thank you.

Registered Owner Legal Name *

Owner Date of Birth *

Contact Phone Number *

Email Address *

How do you want your quote delivered?

EmailCall from AgentEither - Doesn't Matter

Do you have current insurance in force?

Yes
No
No - New Purchase

Please specify your current carrier and premium *

Mailing address *

Mailing City *

Mailing State

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDist of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Mailing Zip Code *

Mooring Address *

Type of Mooring

Marina - Dry StackMarina - Boat SlipCommercial StorageResidence InsideResidence Outside YardResidence Boat LiftOther

Purchase Date *

Purchase Price *

Is this a new purchase?

YesNo

Year of Vessel *

Vessel Length *

Vessel Manufacturer *

Model *

Hull Type

CAT HULLV - HULL

Total Combined Horsepower *

Number of Engines

12345

Engine Mfg *

Type of Engine

Inboard/OutdriveOutboardJet DriveInboard

Year of Engines *

Top CAPABLE speed *

Trailer Year

Trailer Manufacturer

Value of Trailer

Lay up Start Date

Lay up End Date

Do you store your boat in FL for winter?

Yes
No

Please list previous boats owned by Length and Mfg. Please include number of years owned for each *

What boating courses do you have a certificate for?

State Boaters Safety - 5% discountTres Martin Performance - 5% - 10% DiscountUS Power Squadron - 10%USCG - 10%

Total Years of Boating Experience *

Total Years Titled Ownership Experience *

Number of Minor MVR Violations in the last 3 years *

Number of Major Violations in the last 5 years *

Have you had any boating claims in the last three years?

YesNo

If so, how much was paid?

What was the cause of the claim?

Please list any other operators here by name and date of birth

How did you hear about us?

AdvertisementBoatFreaks.comBoat Dealer/Mfg.Current Client - Please list name in notesInsurance AgentOffshoreonly.comOther fourm siteSearch EngineSeriousOffshore.comSpeedwake.comTeamBajaMarine.comOther - Not Listed

Requested Agreed Value *

Requested Deductible

2%3%4%5%

Desired Liability Limit

$100,000$300,000$500,000$1,000,000