Boat Insurance Quote

CGAUX INSURANCE
Rewarding Members with Big Savings!

Rewarding Members with Big Savings!

Boat Insurance Quote Form

Complete and submit the following form to receive a quote in the CGAUX Boat Insurance Program.

* Required

Registered Owners Name: *
Street Address: *
City: *
State: *
Zip Code: *
Phone: *
Date of Birth: *
CGAUX #: *
Email: *
2nd Registered Owners Name:
2nd Owners Date of Birth:
Boat Information
Year: *
Length: *
Manufacturer: *
Model:
Hull Material: *
Propulsion: *
# of Engines: *
Engine Year: *
Engine Make: *
Total Horsepower: *
Fuel: *
Speed: *
Market Value: *
Trailer: (Year, Make)
Trailer Value:
Tender: (Year, Make, Length, Engine)
Tender Value:
Navigation:
Mooring Location In Season: (Address, City, State, Zip) *
Lay-Up:
Lay-Up Location: (City, State, Zip)
Lay-Up From: (mm/dd)
Lay-Up To: (mm/dd)
Safety Equipment	Depth Finder
	VHF
	Radar
	GPS
	EPIRB
	Auto Fire Extinguisher
	CO Detector
	High Water Bilge Alarm
Operator Information
Years of Boating Experience: *
Licensed Captain:
Current Insurance Carrier: *
All Marine Losses (last 5 years): *
Coast Guard Auxiliary Information
CGAUX Member: *
Boat Crew Qualified: *
Coswain: *
Qualified Facility: *
Qualified Facility Usage %: *
Coverage
Liability Limit: *
Additional Information: