Gerry Smith Agency Minnesota Boat Insurance Quote

This request form will provide you with a boat insurance cost and coverage summary based on the information you provide below. This is not an application for insurance. We recommend that you have a current copy of your insurance policy to refer to as you complete this form. After you have completed this form, click the Submit button at the bottom of the page.

PERSONAL INFORMATION
First Name	MI
Last Name
Address
City
*State*
Zip Code
Date of Birth
Drivers License #	State of Lic
Boat Storage Location

Disclaimer
To provide an accurate quote we will ask you a series of questions, some of which we will confirm through consumer reports which may include credit information. This information will be available to our representatives only. For more information, see our Privacy Statement. Do you want to continue?

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COVERAGES
Boat Use
Year of Boat
Value of Boat & Motor(s)	$,000 (in even thousands)
*Length of Boat*	Feet
*Type of Boat*
Horsepower of Motor(s)
Watercraft Deductible
*Value of Trailer*	$
Trailer Deductible
Personal Liability	$
Medical Payments	$

CONTACT INFORMATION
Preferred Method of Contact
*E-mail*
*Phone Number*
*Fax Number*
*Postal Mailing Address*
*Questions or Comments*

Please press the Submit button.
Wait a few moments for an online acknowledgment.

PERSONAL INFORMATION

COVERAGES

CONTACT INFORMATION