**Information received from this Connecticut Boat Insurance quote request form
sent to the William Malloy Insurance 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
Connecticut Boat Insurance policy. We are licensed in Connecticut and will not
provide quotes for other states.
We are your local Fairfield County insurance agency, offering affordable boat
insurance policy services in the following Connecticut cities and counties:
Stamford, Norwalk, Greenwich, Darien, Riverside, Belltown, Springdale, Round
Hill, Old Greenwich, East Norwalk, New Canaan, Glenville, Byram, Cos Cob,
Mianus, North Stamford, Glenbrook, Wilton, Weston, Long Ridge, Noroton,
West Norwalk, Westport, High Ridge, Southport, North Wilton, Winnipauk,
Cannondale, Turn of River, South Wilton, Lyons Plains, Georgetown, Ridgefield,
Branchville, Redding, Topstone, Ridgebury, Redding Ridge, Branchville,
Dodgingtown, West Redding, Titicus, Hattertown, Bethel, Danbury, New
Fairfield, Newtown, Hawleyville, Botsford, Monroe, Bridgeport, Stepney, Shelton,
Huntington, Upper Stepney, Long Hill, Trumbull, Stratford, Easton, Fairfield,
Greenfield Hill, Stratfield, Nichols, Oronoque, Rivercliff, Devon, Lordship, and
East Bridgeport, New Haven, Hartford, Torrington, Waterbury, Meriden, New
Britain, New London, Norwich, Manchester, East Hartford, Suffield, Granby,
West Haven, West Hartford, Branford, East Haven, Hamden, Woodbridge,
Orange, North Haven, Groton, Rocky Hill, Newington, Wethersfield, Glastonbury,
Bloomfield, Blue Hills, South Windsor, Naugatuck, New Hartford, Chesire, East
Lyme, Old Mystic, Wallingford, Southington, Middletown, Bristol, Laurel Beach,
Litchfield, Pleasure Beach, Mystic, North Westchester, Double Beach,
Willimantic, Storrs, Canaan, East Windsor, Vernon, South Canaan, Putnam,
Guilford, Windham, South Britain, Willington, Windsor, East Hampton, Brooklyn,
Westchester, and everywhere else in New Haven County, Litchfield County,
Middlesex County, New London County, Hartford County, Tolland County and
Windham County, CT.
In addition to Connecticut
Boat Insurance, we also offer
affordable Homeowners
Insurance policy premiums or
choose another CT family
insurance coverage from the
list below.
We offer affordable Boat Insurance policy premiums throughout Connecticut!
Applicant Information
Boat Insurance Coverage Information:
Connecticut 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 Connecticut Boat insurance quote request.**


Connecticut Boat
Insurance Quote
Do you have questions
about boat insurance?
Fairfield County Connecticut Insurance Agency
Malloy Insurance Agency
Connecticut Business, Home, Boat
& Car Insurance Specialists
William Malloy
Insurance Agency
87 Glenbrook Road
Stamford, Connecticut 06902
(203) 351-9898
Fax: (203) 351-9880
"Your Fairfield County
Boat Insurance Agent"
Copyright 2004-2008 William Malloy Insurance Agency, Inc. - All rights reserved
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