McAlpin Agency, Inc.

[Home] [Products] [What's New] [Feedback]

Jet Ski Insurance

IIA Logo

If you live outside of Minnesota click on the Agency Link System

Agency Link System

wpe15.jpg (1263 bytes)

This is a request for a Minnesota jet ski insurance quote, not a policy application. Submitting this form does not obligate you to purchase any products. Please complete this form as accurately as possible. Personal Watercraft insurance rates are subject to change.


General Information

Name
Street
City, State ZIP
E-mail
Phone
FAX
Agent Request

Residence Information

Primary Residence
Months at Address

wpe15.jpg (1263 bytes)

Current Jet Ski Insurance Information

Current Insurance Co.

Expiration Date

wpe15.jpg (1263 bytes)

Operator Information (please list all Operators)

Driver #1
Name Birthdate Sex Marital Status Years  Experience

Number of Accidents (Last 5 Years)

Comment on Accidents (Date, Fault, Amount)

Number of Violations (Last 5 Years)

Comment on Violations (Date, Violation Type)

wpe15.jpg (1263 bytes)

Driver #2
Name Birthdate Sex Marital Status Years  Experience
Number of Accidents (Last 5 Years) Comment on Accidents (Date, Fault, Amount)
Number of Violations (Last 5 Years) Comment on Violations (Date, Violation Type)

wpe15.jpg (1263 bytes)

Percentage of Use

  Driver 1. Driver 2.
Snowmobile 1.
Snowmobile 2.

wpe15.jpg (1263 bytes)

Jet Ski Information

Watercraft Unit 1.
Year Make Model Number of CC's Length
Horsepower Maximum Speed Storage Years Owned Value
Weight Describe Any Accessories/Special Equipment Including Cost When New

wpe15.jpg (1263 bytes)

Watercraft Unit 2.
Year Make Model Number of CC's Length
Horsepower Maximum Speed Storage Years Owned Value
Weight Describe Any Accessories/Special Equipment Including Cost When New

wpe15.jpg (1263 bytes)

Trailer Information

Year Make Model Value

wpe15.jpg (1263 bytes)

Coverage's

Liability Coverage. Pays for other people's injuries and damage to their property if you or someone else cause an accident while driving your watercraft. It protects your assets in the event you are held liable for damage to others.

Bodily Injury Liability Comment

Property Damage Liability

wpe15.jpg (1263 bytes)

Medical Expense Coverage. If you and your passengers are injured in an watercraft accident, this coverage pays your medical expenses.

Medical Expense Comment

wpe15.jpg (1263 bytes)

Uninsured and Underinsured Operators Coverage. Pays bodily injury claims if you or your passengers are injured by a negligent uninsured operator, hit-and-run operator or a negligent operator without adequate insurance.

Uninsured/Underinsured Comment

wpe15.jpg (1263 bytes)

Comprehensive Coverage. Pays for damage to your watercraft caused by theft, fire, windstorm, vandalism and many other non-collision occurrences.

Collision Coverage. If your watercraft collides with another watercraft or object, this coverage pays to repair your watercraft.
  Unit 1. Unit 2. Trailer

Comprehensive Deductible

Collision Deductible

wpe15.jpg (1263 bytes)

Comments

wpe15.jpg (1263 bytes)

[Home] [Products] [What's New] [Feedback]
Send mail to mwsmith@visi.com with questions or comments about this web site.

Michael W. Smith Agency

Copyright © 1997 Michael W. Smith Agency
Last modified: February 06, 2007