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REQUEST A QUOTE  --  Marine & Watercraft
Boats and personal watercraft


Click here to download a Microsoft Word printable "Request for Quote" form that you can mail in.

Or, fill out the below form and hit "submit".

Primary Driver    Phone

Address    Date of Birth   

City    State    Zip   
Quotes provided for Illinois, Iowa and Wisconsin residents only.

Social Security Number     (optional)



E-Mail Address


Do you own   or rent your home?


Years Marine Driving Experience    Gender 

Years Auto Driving Experience    Marital Status 

Other Driver(s) 

Name & Date any Auto or Marine Accidents/Moving Violations in the last 5 Years

Date of last Marine/Watercraft Safety Class     

List Memberships in Boating/Marine Clubs and Organizations

Make & Model of Watercraft  Year 

Year, Make & Model of Motor(s)  H

Approximate Current Market Value:     Any Liens/Leases?

Length of Marine Vehicle    Number of Seats 
Protective Devices 

Hull Material  Fuel Type

Storage Location(s) 

Primary Waters Navigated 

Travel Trailer Year, Make & Model 
Travel Trailer Value

List any Accessories installed on your Marine Vehicle

Estimated Value of Accessories

Desired Effective Insurance Date 

Name Existing Insurance Carrier on this Vehicle, if any

Liability/PD Coverage?
20/40/15     25/50/25   50/100/50   100/300/100   250/500/250

Uninsured Coverage   Yes    No

Medical Payments?    None    1000    2500    5000    10,000  

Physical Damage?   Yes     No    Deductible    250    500     1000

Theft Coverage?   Yes    No    Deductible    250     500     1000

Other Notes and Information:

Note: When providing a quotation for an insurance premium, insurance companies may review your credit report and your driving record. No insurance coverage is bound until a) we provide a quote using the information provided here and b) we receive your completed application and premium payment.


Voice  630-204-4178    Fax  815-732-1320
P.O. Box 14   Oregon, IL   61061


Copyright 2004-2006, Riders Choice Insurance Agency, Inc., all rights reserved