Old United

or call toll free at 1-877-812-8216

Annual Package Includes: $15,000 Liability, $1,000 Medical Payments ALL RISKS PHYSICAL DAMAGE - $250 DEDUCTIBLE

*Rate Jet Boats 16 feet and less, under 826-1199 cc’s category.

Applicant Information

All Household Residents over 15 and other Operators

Personal Watercraft Information

Description of Trailer(s)

Coverages Per Unit (6 month policy availaible)

Package: Includes All Risks Physical Damage on Personal Watercraft, $250 Deductible, $15,000 Liability, $1,000 Med Pay
Optional Deductibles:
Increased Liability Package:
Liability Only:
Medical payments may be purchased with Liability Only at a limit:
Watersports Liability Coverage: (This cannot exceed the limit of Liability coverage purchased)
Trailer Coverage: $
Uninsured Boatowners Coverage:
(This cannot exceed the limit of Liability coverage purchased)
Accessories Coverage: List accessories below
$3 premium for every $100 of coverage.
Item 1 Value $
Item 2 Value $
Has vessel been continuously
insured the past 12 months?
1. YesNo
Do you want a 6 month or
annual term policy?
1. 6 months12 months