Total Dollar Insurance LTD Marine Quote

Please fill in the information below as completely and accurately as possible.

Total Dollar Insurance LTD provides Boat insurance through many carriers. With the information you provide, we will shop our many partners and provide you with the policy that best suits your needs.

Boat Owner Information (Primary owner only)

Boat Has How Many Owners? *

First Name *

MI

Last Name *

Address 1 *

Address 2

City *

State *

Postal Code *

Email Address *

Date Of Birth: *

Phone

How many years of boat ownership do you have? *

Does you have any of the following?

State Certified Boating Safety Certificate?

Power Squadron Boating Safety Certificate?

USCG Boating Safety Certificate?

USCG Captains License?

How many operators will there be operating the boat? *

How many claims or losses have any of the owners / operators
had on any watercraft in the past 3 years? *

Boat Information

Who is your boat insured with now? *

Year *

Make *

Model *

Boat Length *

# Engines *

Engine Mfr. *

Engine HP (each) *

Fuel Type? *

Engine Type? *

Maximum Speed? *

Hull Material? *

What dollar amount do you want to insure the boat for? *

What waters will the boat be used? *

What is the address where the boat will be moored? *

Terms and Conditions

Total Dollar Insurance, LTD. provides Boat/Personal Watercraft insurance through many carriers. With the information you provide, we will shop our many partners and provide you with the policy that best suits your needs. The information I am submitting for insurance via this electronic application is true and accurate and does not bind me to accept insurance, nor does it bind the Agent or Total Dollar Insurance, LTD to accept me as an applicant for insurance. If I accept, I hereby authorize any company, credit bureau, or Department of Motor Vehicle that has knowledge of me to give such information to the Agent or Total Dollar Insurance, LTD to be used for Total Dollar Insurance, LTD purposes only. Omitting, misrepresenting or stating information falsely on this application constitutes insurance fraud, voids all coverage, and is subject to criminal and civil penalties. The Total Dollar Insurance, LTD will consider claims history for purposes of determining whether to cancel or refuse to renew your policy.

Fraud Statement
Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. *

I agree with the terms and conditions above. Please process my request.

I do not agree with the terms and conditions above.