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We Are Independent Agents!
We Are An Independent Insurance Agency...

 
As an independent agency, we are dedicated to serving YOU! Polo Insurance has been in business 22 years!

We represent several leading insurance companies rather than any single provider. Therefore, we have the ability to continually monitor the marketplace and offer you the best possible rates.

Our goal is to provide you the highest level of customer service and dedicate our resources to meet your needs and earn your trust. our success is based on your continued satisfaction.

On-Line Boat & Jet Ski
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!


Your Personal Data

Your Name:
Street Address:
City:
State: (Must be Florida)
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
Primary Insured's Occupation:
 
Marital Status:
Single Married
Homeowner?
Yes No
 
Boat Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type N/C)
 
Is this Boat Co-owned?
(If yes, list all owners names)


OPERATOR INFORMATION #1
Name: Birthdate:
Sex (M/F): # Years U.S.
 Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:
Number & Type of Accidents last 3 years: Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years: Number of Years
Boating Experience:


OPERATOR INFORMATION #2 (if none, leave blank)
Name: Birthdate:
Sex: # Years U.S.
 Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations in fields below:
Number & Type of Accidents last 3 years: Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years: Number of Years
Boating Experience:


VESSEL & UNDERWRITING INFORMATION
Year of Boat: Make & Model
(be specific):
 
Boat Length: Hull Type
(wood, Metal,
fiberglass, etc):
 
Max. Speed
(in MPH):
Market Value: $
 
Engine Make: Engine Type:
(Inboard, I/O, Jet)
 
Engine Horse
Power:
Fuel Type:
(Gas, Diesel, etc.)
 
Trailer Cov.
Needed?
Yes No Yr./Make/Model
of Trailer:
 
Trailer Value: $ Where is boat
moored or stored?
 
Describe waters
boat taken on?
Describe boat
general usage?
(fishing, ski, etc.)


VESSEL COVERAGES:
Limits of
Liability:
$15/30 BI / 10 PD $25/50 BI / 15 PD
$50/100 BI / 25 PD $100/300 BI / 50 PD
$250/500 BI / 100 PD
 
Hull Coverage: NO Coverage $250 Deductible
$500 Deductible $1000 Deductible
 
Water Ski
Medical Coverage?
Yes No   Uninsured
  Motorists Cov.?
Yes No
 
Comments or Remarks:
(List additional drivers,
special coverages, etc. here)


Send my quotation via: E-Mail Fax
Regular Mail
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Thank you for filling out this form COMPLETELY!

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a Boat Quote NOW!


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Thank you for visiting the insurance web site of Polo Insurance.com (An online service of Polo Insurance Agency, Inc.)
Home Office at: 12798 W. Forest Hill Blvd. Suite 205A | Wellington, FL 33414 |   Phone:  561-798-5443    |   Fax: 561-793-7586  
Privacy Notice/Copyright Info. | E-Mail: poloins@bellsouth.net   |   More About our Agency   |    2010 Insurance-Web-Sales
Questions or web site-related problems, please E-mail us at: poloins@bellsouth.net