Samel/Paramount Insurance Agency | Request for a Watercraft Insurance Quote (NH)

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serving New England for over 65 years!

Request for a Watercraft Insurance Quote

By completing and submitting this form, you agree that no coverage is bound and no policy is in effect until you are contacted by one of our agency representatives. All information submitted is held in the strictest confidence and is only gathered for the purposes of providing you an insurance quote. To provide the most accurate quote possible, please complete all areas that apply.

Contact Information
Name
Email Address	required
Telephone
Address
City
State
ZIP Code
Preferred Method of Contact
Operators
List names along with their date of birth and if each operator has completed Coast Guard Auxiliary or Power Squadron course:
Boat Information
Is the boat currently insured?
If yes, when does the policy expire?
Type of boat?
What is it used for?
Where is vessel stored?
Waters navigated?
Hull Information
Year Built:
Make and Model:
Hull Type:
Length:	feet
Estimated Market Value:
Maximum Speed:	miles per hour (MPH)
Personal Effects?	(value)
Engines
#1 Engine Year & Make:
Type:
Fuel Type:
Estimated Value:	$ (Outboard only)
Horsepower:
#2 Engine Year & Make:
Type:
Fuel Type:
Estimated Value:	$ (Outboard only)
Horsepower:
Trailer
Trailer?
Make:
Value:	$
Liability
Liability Coverage:
Medical Payments:
Waterski Medical Needed
Has any listed operator been involved in a boating accident within the past 5 years?

If yes, please provide details:
Has your boat and/ or equipment suffered damage from any cause within the past 5 years?

If yes, please provide details:
Has any listed operator been involved in an auto accident or received a moving traffic citation within the past 3 years?

If yes, please provide details:
Additional Comments