The Adams Insurance Agency
A Family Owned and Professional, Independent Insurance Agency
Let us Save You Money
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Boat and Personal Watercraft Insurance Quote Form

Please fill out the form below to get us started on your Quote.  We'll get it going and give you a call within an hour, during normal business hours, to ask a couple of additional questions.  Our follow-up call should take less than 5 minutes and you'll have a price that could save you hundreds of dollars over the year.

Telephone Number:*

Email Address:



First Name:*

Middle Name:

Last Name:*


Male  Female

Date of Birth:*

Marital Status:

Married  Single

Driver's License Number:*

Driver's License Status:


Years Boating Experience:

Name, Date of Birth, and Marital Status of Other Operators:

Driving Record (prior 35 months) for all drivers:

AF/NAF Auto and Boat/PWC Accidents::



Boat Information 

Type (i.e., pleasure, fishing, sail, etc.):*


Year Purchased:




HIN #:

Number of Engines:*

Total Hoursepower (excluding trolling and kicker motors):

 Propulsion Type:




Hull Material:

Max Speed:

Enhanced Performance Modifications (i.e., blowers, superchargers, etc.):

Trailer Coverage:

yes  no

Purchase Year of Trailer:

Rating Base ($; include value of trailer and permanent/portable boating equipment if coverage is desired):


Underwriting/Discount Information


Primary Residence: 

Own a Home/Condo


Own a Mobile Home (10 yr   old or newer)




Live with Parents



Association Name: 



USCG Auxillary


US Power Squadron

Dockage/Mooring/Storage ZIP Code:

Watercraft Use (i.e., pleasure, business, etc.):

Multi-Owner (more than one owner, not in the same household):

yes  no

Prior Boat Insurance:

yes  no

If Yes, Prior Insurance Carrier:

Expiration Date:

 Discounts (select all that apply):



Original Owner


Safety Course




Coverage Information 

 Hull Coverage (Comp & Collision)

Total Loss Replacement (new boats only)


Agreed Value


Actual Cash Value

Hull Deductible (Comp & Collision):

Liability Coverage Limits:

 Uninsured/Underinsured Boater Coverage:

yes  no

Medical Pay Coverage:

Primary Personal Effects Coverage:

Fishing Equipment Coverage (Primary):

Emergency Towing (on-water):

Coastal Navigation:

75 Nautical Miles 


125 Nautical Miles

Roadside Assistance: 

yes  no



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