Massachusetts insurance from O'Connor & Company Insurance Insurance
 
Business Insurance Products from O'Connor & Company Insurance
Businessowners Insurance

General Liability Insurance

Commercial Auto Insurance

Workers Comp Insurance

Apartment Owners Insurance

Strip Mall Owners Insurance



Personal Auto, Homeowners Insurance from O'Connor & Company Insurance
Personal Auto Insurance

Homeowners Insurance

Condo & Townhome Insurance

Renters Insurance

Boat Insurance

Life Insurance

Personal Umbrella Insurance


Other Insurance Services from O'Connor & Company Insurance
Meet the Agents/About Us

Questions & Answers

Office Map/Driving Directions

Our Privacy Notice

Questions? E-Mail Us!


O'Connor & Company
Insurance Agency, Inc.
 
On-Line Boat & Jet Ski
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!
Your Personal Data

Your Name:
Street Address:
City:
State:
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 
Marital Status:
Single Married
Homeowner?
Yes No
 
Boat Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type N/C)
 
Is this Boat Co-owned?
(If yes, list all owners names)

OPERATOR INFORMATION #1
Name: Birthdate:
Sex (M/F): # Years U.S.
 Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:
Number & Type of Accidents last 3 years: Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years: Number of Years
Boating Experience:

OPERATOR INFORMATION #2 (if none, leave blank)
Name: Birthdate:
Sex: # Years U.S.
 Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations in fields below:
Number & Type of Accidents last 3 years: Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years: Number of Years
Boating Experience:

VESSEL & UNDERWRITING INFORMATION
Year of Boat: Make & Model
(be specific):
 
Boat Length: Hull Type
(wood, Metal,
fiberglass, etc):
 
Max. Speed
(in MPH):		 Market Value: $
 
Engine Make: Engine Type:
(Inboard, I/O, Jet)
 
Engine Horse
Power:		 Fuel Type:
(Gas, Diesel, etc.)
 
Trailer Cov.
Needed?		 Yes No Yr./Make/Model
of Trailer:
 
Trailer Value: $ Where is boat
moored or stored?
 
Describe waters
boat taken on?		 Describe boat
general usage?
(fishing, ski, etc.)

VESSEL COVERAGES:
Limits of
Liability:		 $15/30 BI / 10 PD $25/50 BI / 15 PD
$50/100 BI / 25 PD $100/300 BI / 50 PD
$250/500 BI / 100 PD
 
Hull Coverage: NO Coverage $250 Deductible
$500 Deductible $1000 Deductible
 
Water Ski
Medical Coverage?		 Yes No   Uninsured
  Motorists Cov.?		 Yes No
 
Comments or Remarks:
(List additional drivers,
special coverages, etc. here)

How did you hear about us?

Send my quotation via: E-Mail Fax
Regular Mail
Call me by Phone!

Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a Boat Quote NOW!

Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!

O'Connor & Company Insurance Agency, Inc. - PO Box 1458 - Dudley, MA 01571
E-Mail us at: danielO@oconnorinsur.com | View Our Privacy Notice
Our offices are open Monday-Friday 8am-5pm and our Dudley office is open Saturday's from 9am-12noon.
Website Design © 2007, Insurance Web Sales