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We offer Quick Quotes For Watercraft Insurance For Boats Less Than 32ft / Jet Ski Less Than 16ft

Are You Getting The Best Available Coverage & Rates ?

Do You Have A Motor Vehicle Record With Some Prior Tickets / Minor Accidents / No Prior Insurance /Young Operators Ages 14-18 ?

If " Yes " Let Us Help You Get Insured

 

 

  

Personal Watercraft Application  L.O.B. 82    

 

For Underwriting Guidelines Click Here Need help understanding underwritng questions or rules call 1-800-361-8734 !

Label
POLICY TERM

Requested Effective Date

 
Prior Carrier Exp. Date  
NAMED INSURED
First Name M.I. Last Name   Telephone Number    (Area Code)
Address City State County     Zip
Email Address  Fax #          
LIEN HOLDER - FINANCING
Lien Name Loan#              
Address   City State           Zip
AGENT-PRODUCER
Agent  -Tx License Number   Agency Name Phone No. (incl. Area Code)
Address   City State           Zip
ALL HOUSEHOLD RESIDENTS OVER 15 - OTHER OPERATORS UNDER AGE 15 (Use Remarks section below if needed)
Name(s)         BIRTH DATE
MM/DD/YYYY
SOCIAL SECURITY #
000-00-0000
AUTOMOBILE
DRIVERS LICENSE
NUMBER
STATE
ISSUING
LICENSE
% OF USE MARITAL
STATUS
MOTOR
VEHICLE
ACCIDENT(S)
MOTOR
VEHICLE
VIOLATION(S)
PRIOR
LOSSES
Explain any "YES" answers: OPERATOR REQUIREMENTS
No more than five (5) Minor violations in the last 3 years.
         
***DESCRIPTION OF PERSONAL WATERCRAFT - Not to exceed 16 feet in length!Need help with this question call 1-800-361-8734 !
Serial Number Type(s) Year CC's Make/Model Date Purchased **Purchase Price
1.     $
2.     $
3.     $
4.     $
**Actual cash value policy ***Insures only stock manufactured watercraft
DESCRIPTION OF TRAILER(S)
Serial Number Year Make/Model Purchase Price
            $
            $
COVERAGESNeed help with this question call 1-800-361-8734 !
      COVERAGE LIMITS              
Watercraft Liability

                         

Includes Watersport Coverage        
Uninsured Boat Owners  

     

             
Medical Payments  

             
Physical Damage Coverage(ACV)                
               deductible options  

theft deductible          
Accessories

(limit for all units)

$100 deductible

$

 ($100 - $5,000 Limit)        
Number of Trailers  $250 deductible       

           
                         
Min. Written and Earned Premium $100
Discounts that apply:

 
INSTALLMENT BILLING OPTIONSNeed help with this question call 1-800-361-8734 !
         
REMARKS / COMMENTS
 
Producer's Name                                
Agent License #

DISCLOSURES / SIGNATURES

 

FAIR CREDIT REPORTING ACT NOTICE:  In compliance with the Federal Credit Reporting Act (Public Law 91-508), you are advised that the Company may order reports, which may contain or include information pertaining to the character, general reputation, personal characteristic, and mode of living of the applicant and/or other drivers listed in this application.  Upon written request, the complete nature and scope of the investigation will be provided.   

FRAUD WARNING:  Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claims containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and may subject such person to criminal and civil penalties.

PRIVACY POLICY:  I have received and read a copy of the American Reliable Insurance Company/Assurant Group Privacy Policy.  By submitting this application, I am applying for insurance and, at its expiration, for appropriate renewal policies issued by American Reliable Insurance Company.  I understand and agree that any information about me that is contained in, or that is obtained in connection with, this application of any policy issued to me may be used by American Reliable Insurance Company to issue, review, and renew the insurance for which I am applying.

I hereby declare to the best of my knowledge and belief that all of the foregoing statements are true and these statements are offered as an inducement to the Company to issue the policy for which I am applying.  I understand this policy may be cancelled if this application contains any false statement, omission, or material misrepresentation that would have otherwise altered the company's evaluation of the named insured.  I understand that motor vehicle records may be verified.

 

Insured's E-Signature (Enter Full Name Of Person Who Completed Above Application )        

Date Above Application Completed 

 

 

American Reliable Insurance Company Policy Forms Are Mailed , Emailed , or Faxed Along With Each Quote We Provide

Note: These Sample Policy Forms Represent Current American Reliable Insurance Company Personal Watercraft Policy Forms

Coverage proposals presented to you by our Agency may differ; as each insurer represented may offer modified coverage by endorsement or have filed it's own unique policy forms with the Texas Department Of Insurance. Please carefully read any carrier prepared proposal presented to you and where necessary request a copy of each insurance company policy and endorsement form presented; so that you may compare any differences in coverage offered.

 

For Underwriting Guidelines Click Here Need help understanding underwritng questions or rules call 1-800-361-8734 !