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Online Quote Request

Watercraft Insurance Quote

A member of the Pacheco Insurance staff will personally develop a quote suited to your particular insurance needs. We value our customers and take pride in the personal attention we provide.

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This quote form applies to both JetSkis and Boats. All questions refer to both types of watercraft unless otherwise indicated.

Certain sections of this quote refer to Boats only and others to JetSkis only. You may skip over the unapplicable sections by clicking the "Skip" button at the top of each section.

*Required.

Applicant Information

Name*:
Street:
City/State/Zip: / /
Home Phone:
Work Phone:
Email Address*:

Watercraft Type

This quote request is for a: Boat    JetSki

Operator Information (List up to 4 operators)

User 1

Name:
Date of Birth:
Drivers License #:
License State of Issue:
Years of Watercraft Experience:
Minor Violations Last 3 Years:

(List Month/Year for each incident.)
"mm/yyyy, mm/yyyy,.."
Major Violations Last 3 Years:

(List Month/Year for each incident.)
"mm/yyyy, mm/yyyy,.."
At-Fault Accidents Last 3 Years:

(List Month/Year for each incident.)
"mm/yyyy, mm/yyyy,.."

User 2

Name:
Date of Birth:
Drivers License #:
License State of Issue:
Years of Watercraft Experience:
Minor Violations Last 3 Years:
(List Month/Year for each incident.)
"mm/yyyy, mm/yyyy,.."
Major Violations Last 3 Years:
(List Month/Year for each incident.)
"mm/yyyy, mm/yyyy,.."
At-Fault Accidents Last 3 Years:
(List Month/Year for each incident.)
"mm/yyyy, mm/yyyy,.."

User 3

Name:
Date of Birth:
Drivers License #:
License State of Issue:
Years of Watercraft Experience:
Minor Violations Last 3 Years:
(List Month/Year for each incident.)
"mm/yyyy, mm/yyyy,.."
Major Violations Last 3 Years:
(List Month/Year for each incident.)
"mm/yyyy, mm/yyyy,.."
At-Fault Accidents Last 3 Years:
(List Month/Year for each incident.)
"mm/yyyy, mm/yyyy,.."

User 4

Name:
Date of Birth:
Drivers License #:
License State of Issue:
Years of Watercraft Experience:
Minor Violations Last 3 Years:
(List Month/Year for each incident.)
"mm/yyyy, mm/yyyy,.."
Major Violations Last 3 Years:

(List Month/Year for each incident.)
"mm/yyyy, mm/yyyy,.."
At-Fault Accidents Last 3 Years:
(List Month/Year for each incident.)
"mm/yyyy, mm/yyyy,.."

Description of Watercraft

Year:
Make:
Model:
Serial #:
Max HP (Boats) or CC (JetSkis) "## HP" or "## CC"
Length: feet
Max Speed: mph
New/Used: New Used
Registration # (Boats):
1,2 or 3 Passenger (JetSkis):
State of Navigation:
Purchase Date: "mm/dd/yyyy"
Purchase Price: $
Describe any permanently installed or custom equipment:

Description of Motors (Boats Only)

Motor 1

Year:
Make:
Serial #:
HP:
Year Rebuilt (if applicable):

Motor 2

Year:
Make:
Serial #:
HP:
Year Rebuilt (if applicable):

Description of Trailer(s) (Both Boats & JetSkis)

Year: "yyyy, yyyy, ..."
Make: "make, make, ..."
Serial #: "##, ## ..."

Additional Items On Board Boat (Boats Only)

Miscellaneous Equipment:
"Item Description, $ Value, Item Description, $ Value, ..."
Personal Effects:
"Item Description, $ Value, Item Description, $ Value, ..."

Detailed Boat Information

Boat Type:
If, other, describe:
Boat Construction:
If, other, describe:
Area of Navigation: Inland Waters
Great Lakes
Gulf Coastal < 3 Miles
Gulf Coastal 3-25 Miles
Atlantic Coastal < 3 Miles 
Atlantic Coastal 3-25 Miles
Pacific Coastal < 3 Miles
Pacific Coastal 3-25 Miles
San Francisco Bay (not west of Golden Gate)
Lake Powell/Mead

Is extended coastal navigation desired?
Garaging/Mooring During Period of Use:
If, other, describe:

Watercraft Losses in Last 3 Years (Both Boats & JetSkis)

Loss 1

Date of Loss
Cause of Loss
Describe damage to watercraft and equipment:
Was anyone injured? Please explain:
$ Amount of Damage: $

Loss 2

Date of Loss
Cause of Loss
Describe damage to watercraft and equipment:
Was anyone injured? Please explain:
$ Amount of Damage: $

Loss 3

Date of Loss:
Cause of Loss:
Describe damage to watercraft and equipment:
Was anyone injured? Please explain:
$ Amount of Damage: $

General Boat Information (Boats Only)

In what state is the boat primarily navigated?
How many years has the principal operator maintained and operated a watercraft?
Has engine been turbocharged, supercharged, altered or modified in any way for the purpose of enhancing speed or performance? (please describe):
Is this boat the primary residence of the insured? Yes   No
Is this boat titled in the name of or used in the course of the insured's business? (please describe):
Note: Coverage is limited to private pleasure use of owner.
Is craft permanently moored?
If yes, Where (Including Zip Code):
Is this boat currently for sale by the insured? Yes    No
Is the insured boat used for water-skiing? (power boats only):
Yes    No
If yes, is water-skiing liability coverage desired?
Yes    No
Has the principal operator of the boat completed either the US Coast Guard Auxiliary or US Power Squadron introductory courses? (please describe):
(Completion Certificate will be required)
Is your motor's propeller construction other than stainless steel? (please describe):

General JetSki Information (JetSkis Only)

Is personal watercraft modified in any way to enhance speed or performance? If yes, please explain.:
Note: No coverage for race or exhibition.
Is personal watercraft titled in the name of or used in the course of the insured's business?:
Note: Coverage is limited to private pleasure use of owner.
Is personal watercraft currently held for sale and if so, how long has it been for sale?
Where will personal watercraft be stored when not in use? (Including Zip Code):

Response Method

I would like my quote sent to me via: Email
Telephone
Snail Mail
Fax
Fax Number:
Mailing Address:
Street:
City/State/Zip:

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 Other:
Questions or Comments:
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We will send your quote promptly.
Thank you for considering Pacheco Insurance!

Have general questions about your insurance needs? If you would like information on specific types of insurance coverage, but are not yet ready to submit a quote request, send us a message using our online General Information Request. form.

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