What type of insurance are you interested in?*Type of InsuranceCottage InsuranceBoat InsuranceAuto InsuranceHome InsuranceHome or Cottage Rental InsuranceFarm InsuranceCommercial InsurancePostal Code* Personal InformationName* First Last Address Street Address City Province Email Address* Phone*Drivers Licence (Optional)Date of Birth Boating InformationYear vessel was purchased?Year, Make and Model of Boat?Length of BoatTop speed of BoatMotor HorsepowerDo you have a trailer for the boat?*YesNoValue of BoatValue of Boat and TrailerHave you carried insurance on a marine pleasure craft in the past 5 years?YesNoDo you currently have boat insurance?YesNoIf yes, who is the current insurance company?current insurance companyHas insurance ever been cancelled or refused?YesNoIf yes, please provide detailsReason for refusal or cancelationDo you use the boat for any business activities including renting the boat?YesNoDo you take your boat out of Canada?YesNoWhere is boat stored for the winter?Do you have power squadron Certification?YesNoNumber of years you have personally owned a boat in Canada?What was the length (in feet) of the largest boat you have owned?Number of years with experience in Canadian waters (Using a boat owned by you, or owned by a family/friends, rentals/charters)?Did you purchase your boat from Buckeye Marine? *Discounts may applyNoYes Automobile Driving RecordHow many minor moving violations in the last 3 years?0 [None]1234 or moreHow many major moving violations in the last 3 years? (Impaired, Dangerous, Reckless, Excessive speeding, etc.)0 [None]123 or moreHow many at-fault claims or accidents in the last 3 years?0 [None]12 or more
