ALLCHOICE Insurance
Quote – Boat – Surigao – Team – Internal
Quote – Boat – Surigao – Team – Internal
WHAT IS IMPORTANT TO YOU?
(Other Than Price) What Is Most Important When It Comes To Choosing An Insurance Carrier?
(Required)
Claims Service
Financial Rating
Steady Pricing (Limited Price Spikes Up Or Down)
(Other Than Price) What Is Most Important When It Comes To Choosing An Insurance Advisor?
(Required)
An Advisor That Will Educate Me About My Coverages & Offer Advice
Positive Reviews (Ex. Google Reviews)
Anywhere Access (Online, Text, Phone, etc)
Access To Multiple Insurance Carriers
Quick Turnaround On Service Requests
INSURED | CONTACT INFORMATION
Primary Contact
(Required)
First
Last
Mailing Address
(Required)
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Mobile Phone
(Required)
Is It Ok To Text You?
(Required)
Yes
No
Email
(Required)
Ownership & Operator Information
What Type Of Ownership?
(Required)
Individual | Family
Partnership (2 Or More Non-Related Individuals)
Corporation (Corp, LLC, Etc)
Legal Business Name
(Required)
Entity Type
Corporation
LLC
LLP
Federal ID
Number Of Owners | Operators
(Required)
1 (Primary Contact From Above)
1 (NOT The Primary Contact From Above)
2
3
4 or More
Select Which The Largest Number (Owner Or Operator)
Primary Contact Date Of Birth
MM slash DD slash YYYY
Driver's License Number
Driver's License State
North Carolina
South Carolina
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Occupation
Contact Status
Owner
Operator
Both
Name
First
Last
Date Of Birth
MM slash DD slash YYYY
Driver's License Number
Driver's License State
North Carolina
South Carolina
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Occupation
Contact Status
Owner
Operator
Both
Name
First
Last
Date Of Birth
MM slash DD slash YYYY
Driver's License Number
Driver's License State
North Carolina
South Carolina
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Occupation
Contact Status
Owner
Operator
Both
Name
First
Last
Date Of Birth
MM slash DD slash YYYY
Driver's License Number
Driver's License State
North Carolina
South Carolina
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Occupation
Contact Status
Owner
Operator
Both
Name
First
Last
Date Of Birth
MM slash DD slash YYYY
Driver's License Number
Driver's License State
North Carolina
South Carolina
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Occupation
Contact Status
Owner
Operator
Both
OWNER | OPERATOR PRELIMINARY UNDERWRITING
How Many Years Have You Owned A Boat/Watercraft
(Required)
If more than one owner, use the Primary Owner’s Experience
How Many Auto Tickets And/Or Accidents (Last 4 Years)
(Required)
Does Any Operator Have A DUI/DWI Or Reckless Driving?
(Required)
No
Yes
How Many DUI/DWI And/Or Reckless Drivings (Last 4 Years)
Will Watercraft EVER Be Rented Out, Used In Connection With Any Business, Boat Sharing Or Peer-To-Peer Club?
(Required)
No
Yes
Will The Watercraft Be Used Year Round?
(Required)
No
Yes
# of Month NOT Used
(Required)
Boating Safety Course(s) Taken
(Required)
None
ASA
Safety At Sea
USCGA
Licensed USPS
US Sailing
Other State Approved
Prior Boat Ownership History
List Year | Make | Model of all prior boats owned
WATERCRAFT INFORMATION
Type Of Watercraft
(Required)
Boat
Jet Ski
Watercraft Length (in ft)
Year
Make
Model
Number Of Engines
Total Horsepower (All Engines)
What Type Of Coverage Do You Want
(Required)
Liability Only
Physical Damage & Liability
Total Value Of Boat (Including Engine(s))
Value Of Trailer
Waters Navigated
(Required)
Fresh Water | Inland
Salt Water
Both
Do You Currently Own This Watercraft
Yes
No
Year Purchased
Watercraft Purchased From?
Manufacturer
Broker/Dealer
Prior Owner
Auction
Salvor
Transfer From Relative
Other
Watercraft | In-Season Storage Location
Home
Marina
Storage Facility
Boat House
Storage Facility (CAT Rating 4)
Storage Facility (CAT Rating 5)
Rack Storage (Not Rated For CAT 4 or 5)
Dock | Wet Slip
Shed | Private
Garage
Lift | Over Water
Driveway
Yard
Overnight Zip Code
ZIP Code
Zip Code Of Overnight Storage Location
Watercraft | Off-Season Layup Information
Home
Marina
Storage Facility
Boat House
Storage Facility (CAT Rating 4)
Storage Facility (CAT Rating 5)
Rack Storage (Not Rated For CAT 4 or 5)
Dock | Wet Slip
Shed | Private
Garage
Lift | Over Water
Driveway
Yard
Watercraft | Off-Season Storage Type
Dock | In Wet Slip
Driveway
Garage
Lift
Mooring Ball (Afloat)
Rack
Shed
Storage Area
Yard
Other
How Did You Find ALLCHOICE Insurance?
To better serve you and others, we're curious about the channels through which you found us. Did you come across ALLCHOICE Insurance through: SEARCHING ONLINE? (Online Search) SOMEONE TELLING YOU ABOUT ALLCHOICE? (Referral) – or maybe – DID YOU SEE AN AD? (Advertisement)
(Required)
Online Search
Referral
Advertisement
Great! When you conducted the online search, which search engine did you use? (e.g., Google, Bing, Yahoo)
(Required)
Could you please share the specific keywords or phrases you used during your online search to find ALLCHOICE Insurance?
(Required)
After finding us through the online search, what specific factors or information stood out to you that led you to choose ALLCHOICE Insurance?
(Required)
Thank you for sharing! Who referred you to ALLCHOICE Insurance? We'd love to know so we can extend our appreciation.
(Required)
Could you tell us more about your experience with the person or source who referred you to us? Understanding your referral experience helps us enhance our client relationships.
(Required)
Was there anything in particular about the referral that influenced your decision to reach out to ALLCHOICE Insurance?
(Required)
Excellent! Where did you encounter our advertisement? Was it on social media, a website, radio, TV, or elsewhere?
(Required)
Can you recall the content or message of the advertisement that caught your attention? Understanding what resonates with our audience helps us refine our advertising strategies.
(Required)
After seeing our advertisement, what prompted you to take the next step and reach out to ALLCHOICE Insurance? We're interested in knowing what motivated your decision
(Required)
Confirmation
Please review your information to ensure all fields are filled before submitting.
(Required)
I confirm that all the information provided above is accurate and complete.
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