Johnson Insurance Management

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Jet Ski Quote

PLEASE FILL OUT THE FORM BELOW AND SUBMIT FOR A FREE NO-OBLIGATION QUOTE FOR YOUR JET SKI INSURANCE NEEDS:

NORTH CAROLINA RESIDENTS ONLY.

* = Mandatory

Name: *

Leave Blank:

Address 1: *

Address 2:

City: *

State: *

Zip Code: *

Organization:

Home Phone: *

Work Phone:

Fax:

Email: *

Driver 1

Name: *

License & State: *

Sex: *

Date of Birth: *

Tickets (Last 5 Years - Date, Violation): *

Accidents In The Last 5 Years AT FAULT (Date, $, Amount, Personal Injury): *

Accidents In The Last 5 Years NOT AT FAULT (Date): *

Number of Years Licensed: *

Marital Status: *

Good Credit History: Yes No

Driver 2

Name:

License & State:

Sex:

Date of Birth:

Tickets (Last 5 Years - Date, Violation):

Accidents In The Last 5 Years AT FAULT (Date, $, Amount, Personal Injury):

Accidents In The Last 5 Years NOT AT FAULT (Date):

Number of Years Licensed:

Marital Status:

Good Credit History: Yes No

Driver 3

Name:

License & State:

Sex:

Date of Birth:

Tickets (Last 5 Years - Date, Violation):

Accidents In The Last 5 Years AT FAULT (Date, $, Amount, Personal Injury):

Accidents In The Last 5 Years NOT AT FAULT (Date):

Number of Years Licensed:

Marital Status:

Good Credit History: Yes No

Driver 4

Name:

License & State:

Sex:

Date of Birth:

Tickets (Last 5 Years - Date, Violation):

Accidents In The Last 5 Years AT FAULT (Date, $, Amount, Personal Injury):

Accidents In The Last 5 Years NOT AT FAULT (Date):

Number of Years Licensed:

Marital Status:

Good Credit History: Yes No

Personal Watercraft Description (Jet Ski's, Seadoos, etc)

Watercraft 1

Length:

Year:

CC's:

Make/Model:

Date Purchased:

Purchase Price:

Watercraft 2

Length:

Year:

CC's:

Make/Model:

Date Purchased:

Purchase Price:

Personal Watercraft Trailer Description

Trailer 1

Year:

Make/Model:

Purchase Price:

Trailer 2

Year:

Make/Model:

Purchase Price:

Coverages Per Unit *

Package Policy - Includes all risk physical damage on personal watercraft. #250 deductible and $15,000 liability coverage
$25,000
$50,000
$100,000
$300,000 - Only available if there is an umbrella policy

Optional Watersport Liability

Yes

Optional Medical Payments

$1000
$2500

Note: Package policy must be purchased in order to add medical payments

Optional Deductibles

Higher Deductibles reduce the annual premium
$300
$350
$500

Optional Trailer Coverage

Yes
Trailer Value:

Optional Accessory Coverage - List Accessories Value:
Note: Premium is charged for each $100 of coverage

A discount is offered for multi units

No coverage for commercial or rental use

Policies are only written on annual basis

Premium reflects reduced usage during off-season

How would you like to receive your quote: