BOAT OR RV INSURANCE QUOTE REQUEST:
Fill out the form below to obtain a free, no-obligation quote for your boat or other recreational vehicle, and we
will contact you. If you prefer to give information over the phone, fill out the required contact information
below and we will give you a call.
CONTACT INFORMATION:
*Required Fields
*Contact Name:
E-mail: (requested)
*Address:
*City: *State: *Zip Code:
*Area Code: *Phone: Area Code: FAX:
Please indicate how you would prefer us to contact you if we need any additional information.
Phone
Email
Fax
Mail
Have you had continuous watercraft or RV insurance coverage for at least 6 months?
Yes No
If not, why not?
Present Insurance Company
Renewal Date
Do have another policy with Summit Insurance?
Yes No
Vehicle #1
Year
Make
Model
Use of vehicle (list all that apply: pleasure, racing, rented, residence, business, etc.)
Engine/outdrive modified to enhance performance?
Yes No
Idle Assisted Steering device installed on watercraft?
Yes No
Value of Vehicle
Does value include trailer?
Yes No
Zip Code for primary location of RV or watercraft.
Vehicle #2
Year
Make
Model
Use of vehicle (list all that apply: pleasure, racing, rented, residence, business, etc.)
Engine/outdrive modified to enhance performance?
Yes No
Idle Assisted Steering device installed on watercraft?
Yes No
Value of Vehicle
Does value include trailer?
Yes No
Zip Code for primary location of RV or watercraft.
Vehicle #3
Year
Make
Model
Use of vehicle (list all that apply: pleasure, racing, rented, residence, business, etc.)
Engine/outdrive modified to enhance performance?
Yes No
Idle Assisted Steering device installed on watercraft?
Yes No
Value of Vehicle
Does value include trailer?
Yes No
Zip Code for primary location of RV or watercraft.
Driver #1 Information
Driver Name
Occupation
Business
Highest Level of Education
Date of Birth (MM/DD/YYYY)
Gender Male
Female
Marital Status
Single
Married
Divorced
Taken an approved watercraft safety course?
Yes No
Moving violations in last 3 years 0
1
2
3
Please provide the date and a brief description of each violation.
Accidents in last 3 years 0
1
2
3
Please provide the date and a brief description of each accident.
Driver #2 Information
Driver Name
Occupation
Business
Highest Level of Education
Date of Birth (MM/DD/YYYY)
Gender Male
Female
Marital Status
Single
Married
Divorced
Taken an approved watercraft safety course?
Yes No
Moving violations in last 3 years 0
1
2
3
Please provide the date and a brief description of each violation.
Accidents in last 3 years 0
1
2
3
Please provide the date and a brief description of each accident.
Driver #3 Information
Driver Name
Occupation
Business
Highest Level of Education
Date of Birth (MM/DD/YYYY)
Gender Male
Female
Marital Status
Single
Married
Divorced
Taken an approved watercraft safety course?
Yes No
Moving violations in last 3 years 0
1
2
3
Please provide the date and a brief description of each violation.
Accidents in last 3 years 0
1
2
3
Please provide the date and a brief description of each accident.
Comments