Boat and Personal Watercraft Insurance

Name:
SSN: (000-55-5500)
Date of Birth: (mm/dd/yyyy)
Email Address:
Mailing Address:
Home Phone: (555-555-5555)
Work Phone: (555-555-5555)
Marital Status:
Occupation:

Co-Applicant - leave this field blank if no Co-Applicant
Name:
SSN: (000-55-5500)
Date of Birth: (mm/dd/yyyy)
Email Address:
Mailing Address:
Home Phone: (555-555-5555)
Work Phone: (555-555-5555)
Marital Status:
Occupation:

Current Insurer:
expiration date of current policy: (mm/dd/yyyy)
Previous Boats (PWCs) Owned:
By: year, length, and manufacturer
In the last 36 months has any operator been charged/convicted of any motor vehicle violation? yes no
If yes explain:
Has the applicant or this watercraft been involved in an accident, injury or loss within the last 36 months? yes no
If yes explain:
Is this watercraft titled in the name of a company or corporation? yes no
If yes explain:

Watercraft Information

 
Model Yr. Manufacturer Model Length Total HP (PWC CCs)
(yyyy) ft hp
Boat Type

Personal Water Craft, for 1 | 2 | 3 | 4 Passengers
Powerboat
Pontoon
Trawler
Jet boat
Sailboat
Sport Fishing
Houseboat

Engine Type: Fuel Type: Hull Construction:
Inboard
Outboard
Inboard/Outboard
Jet Drive
Gas
Diesel
Electric
Fiberglass
Aluminum
Inflatable
Operating Speeds

Normal Operating Speed:

Top Capable Speed:

Weight Current Value
(including motors)
Purchase Date Purchase Price
(including motors)
$ .00
mm/dd/yyyy
$ .00

Location & Navigation

 
Home Port City:
State:
Zip: (05005)
Is the watercraft stored within 10 miles of Coastal Waters? yes no
Specific local waters primarily navigated:

Program Coverage

 
First Choice Boat Program
($1,000 Med Pay Inc.)

Full Coverage Liability Only*

Liability Limits: (BI/PD/ACC)
25csl
25/25/50
50csl
50/50/100
100csl
100/100/300
100/100/500
300csl
500csl
Waters sports Liability (BI/PD coverage for skiing, towing, etc.)
Increased Med Pay ($10,000)
Limit: $
Hull Deductible Plan:
$250
$500 Standard
$1,000
$1,500
$2,000
Extended Partial Loss Coverage
Trailer ($250 Deductible)
Value: $
Tender/Dinghy ($250 Deductible)
Value: $

Advancement Endorsement
Advancement Plus Endorsement

*Extended Partial Loss, Trailer Coverage, and Advantage/Advantage Plus Endorsements not available within the Liability only option.

Jet Sport Personal Watercraft Program
($1,000 Med Pay Inc.)

Full Coverage Liability Only*

Liability Limits: (BI/PD/ACC)
25csl
25/25/50
50csl
50/50/100
100csl
100/100/300
100/100/500
300csl
500csl
Waters sports Liability (BI/PD coverage for skiing, towing, etc.)
Increased Med Pay ($5,000)
Limit: $
Hull Deductible Plan:
$250 Standard
$500
Trailer ($250 Deductible)
Value: $
Machinery Damage Exclusion Endorsement

Jet Sport Advancement Endorsement
Jet Sport Advancement Plus Endorsement

*Extended Partial Loss, Trailer Coverage, and Advantage/Advantage Plus Endorsements not available within the Liability only option.

 

   

Agreement to Provide Physical Damage Insurance
Property Insurance is required in connection with this loan. Key One Inc. IS the parent company of Key Insurance Agency. Please be aware that you are free to purchase insurance from any agent you prefer for the principle amount of the loan. Use of the service and purchase of any insurance products offered by Key Insurance Agency is at your sole discretion. The insurance policy you are required to purchase is to note the lender's interest with a loss payable clause in the lender's favor.

Authorization to Investigate Credit, Employment and Required Information
I authorize Key One Inc, any of it's subsidiaries , and any other Lender to whom Key One Inc or any of it's subsidiaries may seek to review this application for loan funding purposes to make or have any credit, employment or investigative inquiry that Key One Inc, it's subsidiaries, or any of its chosen Lenders may determine for the extension of credit or the collection of amounts owed by the Applicant and or Co-Applicant. Key One Inc. any of it's subsidiaries, and chosen Lenders, can furnish information concerning my account to consumer reporting agencies and others who may properly receive that information. If I/we ask, I/we will be informed whether or not a consumer report was requested. I/we will be informed of the name and address of the consumer reporting agency that furnished this report. I agree that this application remain the property of Key One Inc. and any of its subsidiaries and chosen lenders.

Key One Inc. and it'd subsidiaries Key One Mortgage, Inc. acts as a consultant only on Real Estate transactions for the benefit of the home purchaser and as a referral source to qualified brokers and Lenders.

By Submitting this application I agree to hold Key One Inc. and any of it's subsidiaries harmless if financing cannot be secured and the loan for which I am applying cannot be furnished for any reason.

I certify that no essential information has been concealed and that no misrepresentations have been made in this application.

 

Verification Code

Please enter the verification code; it is not case sensitive: