Boat Ins. Purl

Boat Ins. Purl

This Boat PURL is used to collect risk information for the purpose of quoting. Do not give or share with clients, in house use ONLY.
Completed By:
Agency Name *
enter agency prefix
Producer Names (LSI) *
Producer Names (Rouland) *
Producer Names (HRC) *
Producer Names (JCI) *
Producer Names (Elite One) *
For edit submission
Date *

Month Day Year
Date
Time *

: Hour Minutes AM/PM Option
How did you hear about us? *
Referred by: *
If known otherwise type Unknown
Notes:
Prior Ins. Policy Info:
Prior Carrier *
Name of Carrier
When does the policy expire
enter the exp/renewal date
First Applicant:
First & Last Name (1st applicant) *
as listed on driver license
Will be listed as Driver? (1st applicant) *
Reason for Exclusion *
Explain why Excluded: *
Applicant Home Number:
Gather if not in client file already
Applicant Mobile Number:
Gather if not in client file already
Applicant Email Address:
Gather if not in client file already
Birthdate *
Date
Gender: *
Marital Status: *
Driver License Number *
License State *
Employment Status *
Occupation / Job Title *
Example: Science or Engineering Degree
Second Applicant:
First & Last Name (2nd applicant) *
as listed on driver license
Will be listed as Driver? (2nd applicant) *
Relationship to First Named Insured: *
Reason for Exclusion *
Explain why Excluded: *
Birthdate *
Date
Gender: *
Marital Status: *
Driver License Number *
License State *
Employment Status *
Occupation / Job Title *
Example: Science or Engineering Degree
Applicant Address:

Storage/Garage Address (map it) *

	Address
Street
City
State
Zip

garage address holder
Address Type

app 1 address holder
Add Driver? (1st driver) *
First & Last Name (1st driver) *
as listed on driver license
Relationship to First Named Insured (1st driver) *
Birthdate (1st driver) *
Date
Gender (1st driver) *
Marital Status (1st driver) *
Driver License Number (1st driver) *
License State (1st driver) *
Employment Status (1st driver) *
Occupation / Job Title (1st driver) *
Example: Science or Engineering Degree
Add Another Driver? (2nd driver) *
First & Last Name (2nd driver) *
as listed on driver license
Relationship to First Named Insured (2nd driver) *
Birthdate (2nd driver) *
Date
Gender (2nd driver) *
Marital Status (2nd driver) *
Driver License Number (2nd driver) *
License State (2nd driver) *
Employment Status (2nd driver) *
Occupation / Job Title (2nd driver) *
Example: Science or Engineering Degree
Add Another Driver? (3rd driver) *
First & Last Name (3rd driver) *
as listed on driver license
Relationship to First Named Insured (3rd driver) *
Birthdate (3rd driver) *
Date
Gender (3rd driver) *
Marital Status: *
Driver License Number (3rd driver) *
License State (3rd driver) *
Employment Status (3rd driver) *
Occupation / Job Title (3rd driver) *
Example: Science or Engineering Degree
Add Another Driver? (4th driver) *
First & Last Name (4th driver) *
as listed on driver license
Relationship to First Named Insured (4th driver) *
Birthdate (4th driver) *
Date
Gender (4th driver) *
Marital Status: *
Driver License Number (4th driver) *
License State (4th driver) *
Employment Status (4th driver) *
Occupation / Job Title (4th driver) *
Example: Science or Engineering Degree
Add Another Driver? (5th driver) *
First & Last Name (5th driver) *
as listed on driver license
Relationship to First Named Insured (5th driver) *
Birthdate (5th driver)) *
Date
Gender (5th driver) *
Marital Status: *
Driver License Number (5th driver) *
License State (5th driver) *
Employment Status (5th driver) *
Occupation / Job Title (5th driver) *
Example: Science or Engineering Degree
Policy Coverage:
Liability (Bodily Injury)
Limit per person
Liability (Bodily Injury)
Limit per accident
Liability (Property Damage)
Limit per accident
Uninsured Boaters (Bodily Injury)
Limit per person
Uninsured Boaters (Bodily Injury)
Limit per accident
Medical Payments
Limit per accident
Vehicles on Policy:
1-Type of Boat/Yacht *
Usage *
Hull ID Number *
verify the value thru KBB
Year of Vehicle *
Vehicle Make *
Vehicle Model *
Sub Model *
Actual Cash Value *
Propulsion Type *
Number of Motors *
Horsepower per Motor *
Fuel Type *
Maximum Boat Speed *
Length (feet) *
Ownership Type *
Purchased Date *

Month Day Year
Physical Damage Coverage (Full Coverage):
Quote Physical Damage for this vehicle *
Comprehensive Deductible) *
Collision Deductible *
Personal Property/ Personal Effects Coverage *
Cannot be purchased without collision
On Water Towing *
Towing and labor
2-Type of Boat/Yacht *
Usage *
Hull ID Number *
verify the value thru KBB
Year of Vehicle *
Vehicle Make *
Vehicle Model *
Sub Model *
Actual Cash Value *
Propulsion Type *
Number of Motors *
Horsepower per Motor *
Fuel Type *
Maximum Boat Speed *
Length (feet) *
Ownership Type *
Purchased Date *

Month Day Year
Physical Damage Coverage (Full Coverage):
Quote Physical Damage for this vehicle *
Comprehensive Deductible) *
Collision Deductible *
Personal Property/ Personal Effects Coverage *
Cannot be purchased without collision
On Water Towing *
Towing and labor
3-Type of Boat/Yacht *
Usage *
Hull ID Number *
verify the value thru KBB
Year of Vehicle *
Vehicle Make *
Vehicle Model *
Sub Model *
Actual Cash Value *
Propulsion Type *
Number of Motors *
Horsepower per Motor *
Fuel Type *
Maximum Boat Speed *
Length (feet) *
Ownership Type *
Purchased Date *

Month Day Year
Physical Damage Coverage (Full Coverage):
Quote Physical Damage for this vehicle *
Comprehensive Deductible) *
Collision Deductible *
Personal Property/ Personal Effects Coverage *
Cannot be purchased without collision
On Water Towing *
Towing and labor
Attachments: (Optional)

Upload a File
Copy of Policy, Drivers License, ETC Cancel of
Notes:
Collect Quote info another LOB *

Auto Home (HO3) Renters (HO4) Condo (HO6) Landlord (DP3) Earthquake Flood RV Motorcycle Umbrella Vacant Land PAF No Other LOB (transfer to CPA now) No Other LOB (send to LSI Quoting Team)
Are you ready to send to CPA and validate *

Yes No
Now choose the CPA to help you find a market *

Standard Boat CPA Yacht CPA Vintage/Classic Boats CPA Watercraft/Jet Ski CPA None (do not proceed to CPA)
* If you want to send to LSI Quoting Team to do the CPA do not answer the 2nd question or select "None (do not proceed to CPA)" then select "No Other LOB (send to LSI Quoting Team)" on the first question.
* This will transfer the client info to another quote form to save time. Example - if a client calls for an auto quote but also wants a home quote. Then you can transfer the data to the home quote form and eliminate typing the same information multiple times
Should be Empty: