Boat Quote Request | HH Insurance | SW Florida Insurance

Are you a New or Existing Client?*

New Client
Existing Client
AnswerLink

Please Provide Salesforce Account URL*

Name of Caller

Contact Information on File is Current*

Yes
No

Updated Contact Information*

Phone number	Email

Drivers License Number on File?

Yes
No

Insured Information*

First Name	Last Name	Phone number	Email	Date of Birth

Drivers License Number

Drivers License State

Mailing Address on File Is Current

Yes
No

Address

Rent or own your primary residence?

Rent
Own

Boat Information

Is this a new Purchase or Currently owned?

New Purchase
Currently Insured
Uninsured

How many years have you owned the boat we are quoting today?

Purchase Date

How do you plan on using the vessel?

Charter
Private Pleasure
Live Aboard
Other

You selected other, please describe:

You Selected Charter- Please describe the charter operation:

What Liability Limits do you require?

Will you have a paid crew aboard

Yes
No
Other

You selected other, please describe:

Captain's Name

First Last

Average number of passengers:

Maximum number of passengers:

Average number of trips per year:

Maximum number of trips per year:

Tell me about your boat:

Purchase Price	HIN #	Year	Make	Model	Number of engines

Is the purchase price:

Greater than $350k
Less than $350k
Unknown

Length of Boat (# of feet)*

Anti-theft GPS Tracker present?

Yes
No
Unknown

If yes, what brand?

Engine Information

Year	Make	Model	Horsepower

Does the boat have Outboard or Inboard Engines?

Outboard: an engine is mounted outside the hull of the craft
Inboard: an engine enclosed within the hull of the boat

For Inboard Engines, is there an automatic fire suppression system or fume detector?

Yes
No
Not sure

Operator information

Years of Boating Experience*

Has a Boating Safety Course Been Taken?*

Yes
No

Additional Operators?

Yes
No

Please complete for each additional operator.

First Name	Last	Date of Birth	Driver's License #

Please list any Boats You Have Owned in the Past and the Years You Owned Them:

Owned From (Year)	Owned To (Year)	Make	Length

Have you had any boat insurance claims in the last 5 years?*

Yes
No

If Yes, complete the following:

Claim 1 - Approx. Date:

Claim 1 - Description:

Claim 1 - Approx. Amount Paid:

Claim 2 - Approx. Date:

Claim 2 - Description:

Claim 2 - Approx. Amount Paid:

Additional quoting information

Coverage for Bahamas?*

Yes
No
I would like to know more

Storing Location of Boat*

Please Confirm House Address:

If boat is stored or moored at a residence, please confirm the address here.

Street Address Address Line 2 City State ZIP Code

Name of Marina

Location of Marina

How is the boat stored?

Trailer
Lift
In the Water

What is your hurricane plan?

Trailer Information

Year	Make	Model	Length	Value

Trailer Information

Year	Make	Model	Length	Value

Have you worked with HH Insurance in the past?

Yes
No

How did you hear about us?*

Other - How did you hear about us?*

Which Dealership?

Who was your salesman?

Who's your lender?

Who's your friend or relative?

Who's the employee?

If Marina: Same Marina where stored? If not, which marina?

Request Current Declarations

Client will Email or text pdf documents to sales@hhinsgroup.com
Client will send photo of documents via email or text to sales@hhinsgroup.com
Client will fax documents to HH service fax number (727)601-0988
Client will mail documents to HH home office 3443 1stAve N St. Petersburg, FL 33713
Client denied request for declarations page and team member reassured client, dec is for apples-to-apples coverage comparison.

Quote Request Taken By*

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