Boat Insurance Quote - Laura Harris Agency Inc. of Texas

Laura Harris Agency Inc.
Professional Service

5350 S Staples St Suite 150
Corpus Christi, TX 78411
361-985-2875
361-985-0509 (fax)

E-mail:dawneperez@allstate.com

Our agency is licensed to quote and write insurance policies only in Texas. To find agents offering these coverages in all other states, please click the IQ.net logo.

Boat Insurance Quote
Completely fill out and submit this form to our agency to receive an accurate quote. You MUST provide at least one method of contact to receive a quote from our agency.
Personal Information

Name (required)

E-Mail Address (required)

Address

City/State/Zip(required)

Home Phone

Work Phone

Fax

Operators

First Name Birthdate Has Operator completed Coast Guard Auxiliary or Power Squadron course?

#1

#2

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Boat Information (ALL INFO REQUIRED)

Boat Currently Insured?

Policy Expires Month/Year

Current/Desired Policy Deductible

Boat Type

Use

Where is vessel stored

Waters Navigated

Used for Racing?

Hull

Make/Model

Hull Type

Length

Estimated Market Value

Year Built

Max Speed (in MPH)

Personal Effects? (Amount)

Misc Boating Equip? (Amount)

Engine(s)

#1 Engine

Make Year

Type

Fuel Type

Est. Value (O/B Only)

Horse Power

#2 Engine

Make Year

Type

Fuel Type

Est. Value (O/B Only)

Horse Power

Trailer?

If Yes

Make

Value

Liability Coverage

Liability

Medical Payments

Water Ski Medical Needed

Explain all yes answers below

Has any listed operator been involved in a boating accident within the past 5 years?

Has your boat and / or equipment suffered damage from any cause within the past 5 years ?

Has any listed operator been involved in an auto accident or received a moving traffic citation in the past 3 years?

Remarks

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Operators
First Name	Birthdate	Has Operator completed Coast Guard Auxiliary or Power Squadron course?
#1
#2
#3