Gallagher Charter Lakes Logo

Marine Insurance Quote

Are you an insurance agent or broker? Agents and brokers will be redirected to the full application form.
Name / Vessel Owner  
Email Address  
Day Phone  ( )  -  
Social Security Number
(optional) Why?
 -  -
Are you Married?  
Do you own or rent your home?  
Date of Birth    ,   
Vessel Use  
Vessel Use, if other than above:
Year Vessel Built  
Length  FT. 
Model of Vessel  
Number of Engines  
Engine Manufacturer  
Engine Horsepower Each  
Fuel Type  
Vessel Value  
Trailer Value (if applicable)
Liability Amount  
Navigation Area  
Mooring City  
Mooring State  
Mooring Zipcode  
If the boat is layed up, what
are the months of layup?
Years of Ownership Experience  
Have you had a loss
in the last 5 years?
Current Insurance Carrier
Current Annual Premium
Is there a specific agent you
would like to work with?
How did you hear about us?
Is your vessel used for chartering, guides or a passenger vessel?


In connection with this insurance and to offer you an accurate quote, the insurance company may obtain or use a credit-based insurance score as part of the insurance underwriting process. The information used to develop the insurance score comes from TransUnion or another 3rd party provider. A credit-based insurance score will not impact your, or your client’s, credit rating or credit score. Clients in West Virginia may request recalculation of your credit-based insurance score once every 12 months. Clients in New York and Texas are required to sign a disclosure form. This form will be provided if required.