Request a Quote | Admiralty Insurance Agency

Quote

Contact Information

2 Central Street
Winchester, MA 01890

Phone: 781-721-5500
Fax: 781-721-5509

Quote Form

To get a quote for your vessel please complete the following form.

If questions arise or you need clarification about anything below, please feel free to contact us directly.

We are more than happy to assist!

Vessel Owner Information

Full Name

This field is required.

Street

This field is required.

City

This field is required.

State

Please select an option.

ZIP

This field is required.

Primary Residence

Own Rent Other

Please select an option.

Marital Status

Please select an option.

Date of Birth

This field is required.

License Number

This field is required.

Cell Phone

This field is required.

Email

This field is required.

Vessel Information

Manufacturer of Vessel

This field is required.

Model

This field is required.

Year Built

This field is required.

Length Over All (LOA)

This field is required.

Hull ID Number

This field is required.

Manufacturer of Engine

This field is required.

Number of Engines

This field is required.

HP Engine (each)

This field is required.

Fuel Type

Gas Diesel

Please select an option.

Use of Vessel

Use

Pleasure Charter

Navigational area (check all that apply):

New England
Full East Coast
Bahamas
Caribbean

Other

Mooring and Storage

In-Season Mooring Location (June- November)

Slip Mooring Private Residence

Please select an option.

Marina Name / Private Residence

Street

City

State

ZIP

Off-Season Storage Location

Hauled-Out Afloat

Please select an option.

Marina Name / Private Residence

Street

City

State

ZIP

Lay Up Dates (Months)

This field is required.

Current Location of Vessel

City

State

Please select an option.

ZIP

This field is required.

Additional Details

Loss Payee / Bank / Lien Holder?

Yes No

If yes, name and address of Lien Holder

Any Racing to be Done with Vessel?

Yes No

Please select an option.

Any Paid Captain and/or Crew?

Yes No

Please select an option.

Boating Experience

Prior Boats Owned (1)

Prior Boats Owned (2)

Prior Boats Owned (3)

Boating Courses Taken (check all that apply):

State Course
US Coast Guard Auxiliary
US Power Squadron
US Captain's License

Other

Marine Losses in Past 5 Years?

Yes No

Please select an option.

Motor Vehicle Record (check all that apply):

DUI
DWI
OUI
Speeding in the Last 3 Years

Has Any Carrier Canceled or Refused Yacht Insurance?

Yes No

Please select an option.

Secondary Operator

Name

Date of Birth

This field is required.

Boating Experience

Costs and Coverage

Cost of Primary Vessel

This field is required.

Cost of Dinghy

Cost of Outboard

Cost of Trailer

Deductible Requested

1% 2% 3%

Please select an option.

Liability Requested

$300K $500K $1M

Please select an option.

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