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GFSC
Boat Insurance
- Online Quote
Fill out and submit the form below
and a Georgelas Financial Service Corporation representative will contact you
at the email address you provide below.
Primary insured
Applicant Name
Email address
*
(required for contact)
Date of Birth
Address
Driver's Licence #
Citations/Accidents
Prior Years Boat Ownership
Name and phone numbers of all contacts
1. name
phone
2. name
phone
3. name
phone
4. name
phone
5. name
phone
Other Boat Operators in Household
Boat operators in HH
select one
0
1
2
3
4
OTHER THAN MYSELF
Name of Other
Date of Birth
Driver's Licence #
Citations/Accidents
Name of Other
Date of Birth
Driver's Licence #
Citations/Accidents
Name of Other
Date of Birth
Driver's Licence #
Citations/Accidents
Name of Other
Date of Birth
Driver's Licence #
Citations/Accidents
Boat Information
Year
Make
Model
Hull ID
Length
ft Horsepower
Boat Engine Type
select one
Inboard
Outboard
Inboard-Outboard
Jet
Coverage Type
select one
Full (collision & liability)
Liability only
On Lease
Yes
No
Lienholder
Yes
No
Boat Value
$
Motor Information
Year
Make
Model
Serial #
Motor Value
$
Trailer Information
Year
Make
Model
Serial #
Trailer Value
$
Coverage Information
Liability Limits Wanted
$
select one
100,000
300,000
500,000
1,000,000
Deductible
$
select one
0
50
120
250
500
750
1,000
1,500
Towing
Yes
No
Extras
Provide item(s) and value(s)
1842 So. Main Street - Salt Lake City, UT 84115 | 801.487.8661 |
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