Jerry Brunson Insurance Agency
Managing today's risks to ensure tomorrow's rewards
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Boat/Watercraft Insurance Quote
We would like to provide you with a free, no-obligation boat/watercraft insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

Please Note: By completing this form, you are giving your consent that we may access any consumer reports necessary to obtain an accurate quote. These reports include claim loss reports, motor vehicle division reports and consumer credit reports.

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Personal Information
Name:
Address:
City:   State:   Zip:
Day Phone:   Night Phone:
Best Time To Call:   AM   PM
Email Address:

 
Current Boat/Watercraft Insurance Information
Company Name (not agency):
Policy Expiration Date:   Premium Amount: $
Term: 6 Months  1 Year  Other:

 
Coverages
(input only for those desired)
Type
Sums Insured
Type
Sums Insured
Hull- Physical Damage $ Tender / Dinghy $
Liability Coverage $ Crew Liability $
Owner / Operator M&C $ Medical Payments $
Commercial Passenger Liability $ Uninsured Boater $
Trailer $ Personal Property $
Non-Emergency Towing $ Other $

 
Vessel Information
Manufacturer/Model:
 
Year
 
Length
Date
Purchased
Purchase
Price
Present
Value
Max
Speed
 
Registration #
$ $ mph
Hull Identification #: Waters to be navigated:
Tenders or Dinghies: Storage Address (Street, City, Co., St.):
Stored on Trailer:
Y   N

 
Equipment
(please select ALL equipment on your Boat/Watercraft)
Bilge Pumps CO2/Halon System Aux Generator, Diesel
EPIRB Fume Detector Aux Generator, Gas
Sonar Fire Extinguishers
Other (list below)
Depth Sounder Cooking Stove
LORAN/ Direction Finder Engine Alarm
GPS Anti-theft Devices
Radar Life Raft
SATNAV/ OMEGA Ship to Shore Radio

 
Miscellaneous
(please check ALL that apply)
Primary Power
Type of Hull
Hull Material
Fuel Tank
Sail Sailboat Wood Metal
Outboard Performance Metal Fiberglass
Inboard Runabout Fiberglass
Inboard/
Outdrive
Personal Watercraft
Other

 
Engine/Outboard Motor Information
(please complete for each engine)
Eng
H.P.
Gas
Diesel
Year
Date
Purchased
Purchase
Price
Present Value
1
$
$
2
$
$
3
$
$
Manufacturer/Model Serial Number
1
2
3

 
Trailer Information
Year
Date Purchased
Purchase Price
$
Present Value
$
Manufacturer/Model:
Serial #:

 
Operators
(always list insured as Operator #1)
 # 
Name
DOB
Auto DL #
State
Social Security #
USCG/Power Squadron
Certificate
1
2
n/a
3
n/a
#
Auto Violations/Suspensions in last 5 years:
Years of Boat Ownership:
1
2
3

 
Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you have additional information where there was not enough fields above, such as additional operators, coverages, etc..., please enter them here.


Disclaimer
I understand that this submission does not constitute an application for insurance, but is rather a request for a quote for the above name risk based upon the information I have provided.

 I have read and agree with the above disclaimer.
  (Box must be checked before request can be sent)


Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

   


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Jerry Brunson Insurance Agency
1726A General George Patton Drive
Brentwood TN 37027
Map to Office
     Office: 
Fax: 
Email: 
615.246.0101
888.717.7975
info@jerrybrunson.com

Important Note: This website provides only a simplified description of coverages and is not a statement of contract. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.

   

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