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  Gerry Smith Insurance Agency
12280 Nicollet Ave, Suite 104
Burnsville, MN 55337-1999

Ph  (952) 224-7029
Fax (952) 224-0400
gsmith@mnchoiceinsurance.com

 

 
 
Minnesota Personal Watercraft Insurance Quote Inquiry Form
This inquiry form will allow us to provide you with a personal watercraft insurance cost and coverage summary, based on the information that you enter below. 

Note: This is not an application for insurance coverage.  

We recommend that you have a current copy of your insurance policy or declarations page to refer to as you are completing this form. When you have finished entering your information, 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 
Watercraft 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?

I have read the disclaimer and want to continue: Yes No

COVERAGES

Year of Watercraft
Manufacturer of Watercraft
Model of Watercraft (be specific)
Current Value of Watercraft $,000 (in even thousands)
Type of Watercraft
CC Size
Watercraft Damage Deductible
Current Value of Trailer $
Trailer Damage Deductible

Personal Liability

$
Medical Payments

$

Water-skiing & Towing Sports Liability (must match Personal Liability Limits) 

Yes   No

Uninsured Watercraft Liability               (must match Personal Liability Limits) 

Yes   No

Towing & Assistance  

Yes   No

Accessories                    Yes     No  

$ Value   

 

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.

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