In addition to New Jersey
Boat Insurance, we also
offer affordable Home
Insurance policy premiums
or choose another NJ
family insurance coverage
from the list below.
**Information received from this New Jersey Boat Insurance quote
request form sent to American Insurance Services Agency will be for our use only
and will not be sold, given to or distributed to any other parties. A quote will be based
on the boat insurance policy information provided and does not guarantee
acceptance of the risk by us. The precise coverage afforded is subject to meeting
underwriting guidelines, and the terms, conditions and exclusions of the policy as
issued. By submitting this request you acknowledge that this is neither an offer to
insure nor a guarantee of insurance. Completion of this form does not entitle you
to a New Jersey Boat Insurance Policy. We are licensed in New Jersey and
will not provide quotes for other states.
"Your Local New Jersey Boat Insurance Policy Agent!"
We offer affordable New Jersey boat insurance policy premiums to residents of the
following NJ counties and cities: Union County, Essex County, Bergen
County, Passaic County, Sussex County, Morris County, Warren County,
Hunterdon County, Somerset County, Middlesex County, Monmouth County,
Mercer County, Burlington County, Clark, Newark, Jersey City, Elizabeth, Rahway,
Colonia, Iselin, Avenel, Woodbridge, Port Reading, Carteret, Perth Amboy, Fords,
South Amboy, Metuchen, Plainfield, Dunellen, South Plainfield, Green Brook,
Fanwood, North Plainfield, Cranford, Scotch Plains, Westfield, Union, Millburn,
Springfield, Mountainside, Gillette, Warren, Watchung, Stirling, Millington,
Middlesex, Martinsville, Piscataway, Edison, New Brunswick, Highland Park, North
Brunswick, Sayreville, East Brunswick, Somerset, Milltown, South River, Bound
Brook, Somerville, Bridgewater, Bayonne, Linden, Roselle, Hoboken, Union City,
Weehawken, West New York, Guttenberg, Cliffside Park, Edgewater, North Bergen,
Secaucus, Fairview, Ridgefield, Fort Lee, Leonia, Palisades Park, Englewood Cliffs,
Englewood, Bergenfield, Teaneck, Paramus, Bogota, Ridgefield Park, Little Ferry,
Hackensack, Maywood, Teterboro, South Hackensack, Rochelle Park, Moonache,
Lodi, Hasbrouck Heights, Saddle Brook, Garfield, Elmwood Park, Woodridge,
Carlstadt, East Rutherford, Lyndhurst, Rutherford, Wallington, Passaic, Clifton,
Paterson, Totowa, West Paterson, Little Falls, Great Notch, North Caldwell, Cedar
Grove, Verona, Montclair, Bloomfield, West Orange, Glen Ridge, Belleville, Nutley,
Kingsland, North Arlington, Kearney, Harrison, East Orange, East Newark, Orange,
Irvington, South Orange, Hillside, Townley, Livingston, Wayne, Trenton, Camden,
Atlantic City, Princeton, Vineland, Willingboro, and Toms River, NJ.
Applicant Information
Boat Insurance Coverage Information:
New Jersey Boater Information:
Full Name:          
Home Address:
City:     State:     Zip Code:
Email Address: (Required) 
Home Phone:   Work Phone:   Ext.
How to Contact You:
Date of Birth:              (mm/dd/yyyy)
Gender:         Marital Status:
Current Insurance Company: 
Policy Expiration Date:          (mm/dd/yyyy)



  Boat       Year          Builder               Model            Vessel Type   Length
     1        
     2        

Engine Information:
  Boat       Year       Engine Type       Manufacturer      How Many Engines
    1              
    2              

Mooring/Storage Location
  Boat
     1      
     2      

What types of safety equipment is on your vessel(s)?
(check as many boxes as desired)
  Boat
     1   VHF    Depth Finder    SAT NAV    Auto Halon
          EPIRB    SSB    GPS    Radar
          Loran    CO-2    Fume Detector    Other
     2   VHF    Depth Finder    SAT NAV    Auto Halon
          EPIRB    SSB    GPS    Radar
          Loran    CO-2    Fume Detector    Other

Is boat used on any private lakes?
  Boat
     1      
     2      

Is this a promotional/Memo boat?
  Boat
     1      
     2      

Is boat used for guide service or chartering?
  Boat
     1      
     2      

Is boat used for residence?
  Boat
     1      
     2      

Is boat used for waterskiing?
  Boat
     1      
     2      

Is your driving record accident & violation free during the past 5 years?
  If No, how many accidents?    How many violations? 



Boat Insurance Coverages Desired For?
(check as many boxes as desired)
Boat(s)    Motor(s)    Equipment    Trailer


                    Liability                  Uninsured                                           Collision         Comprehensive
  Boat    Limits(x $1,000)      Boater(x $1,000)       Medical              Deductible           Deductible
     1                                 
     2                                 

Any boating claims of losses to vessel(s) or from liability in the past 5 years?
Description of losses:


Additional Information or Comments


Click on the "Submit Quote Information" button below to
send your New Jersey Boat insurance quote request.**


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American Insurance
Services Agency
1129 Raritan Road
Clark, New Jersey 07066
(732) 680-4444
Fax: (732) 680-4067
"We're Your New Jersey
Boat Insurance Agent"
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