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)
County
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) HP
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 info@callriderschoice.com P.O. Box 14 Oregon, IL 61061
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