Baja Marine Insurance Program // BAJA NBOA Membership Activation & Registration

BAJA NBOA Membership Activation & Registration

Please complete the following information to receive a free Marine Insurance Quote. Items in RED are required!

Read Terms & Conditions for NBOA Towing Benefit

NBOA PASSPORT CODE:

Boat Owner Information

First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

County:

Phone: (XXX-XXX-XXXX)

Fax: (XXX-XXX-XXXX)

Date of Birth: (MM/DD/YY)

Marital Status:
Single Married Widowed
Years Boating Experience:

New Purchase:
Yes No
Expected Delivery Date:

Claims on Boat:
Note: explain YES in comments below
Yes No
Violations on Driving Record:
Note: explain YES in comments below
Yes No
Certified:

Other Vessels Operated & Number of Years for Each

Boat Information

Hull Information

Hull Type:

Year:

Length (LOA - ft):

Manufacturer's Name:

Specific Model:

Boat Type:

Engine Information

Engine Year:

Engine Manufacturer:

Number of Engines:

Horsepower each Engine:

Engine Type:

Fuel Type:

Equipment Information

Please check all that apply
VHF
Depth
Loran
Compass
Radar
GPS
EPIRB

Fume Detector:
Yes No

Fire Equipment Type:

Boat Use Information

Use of Boat:

Live Aboard
Paid Captain
Paid Crew
Waterskiing

Navigation Area:

Lay up dates:

Afloat:

Ashore:

Boat/Motor Storage Location

Location City:

Location State:

Location Zip:

Current or Desired Coverage

If you do not have current coverage type none in both blanks below.

Current Company:

Policy Expiration Date:

Coverage Amounts

Hull Value (include equipment and engines):
$
Liability:

Medical Payments:

Towing:

Boat Trailer (Approx. Value):
$
Deductible (% of Hull Value):

Current Annual Premium:
$

Email & Comments

Your Return Email Address:

How did you find us?

Notes:

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. An insurance score uses information from your credit report to help predict how often you are likely to file claims and how expensive those claims will be. The information used to develop the insurance score comes from TransUnion. A credit-based insurance score will not impact your credit rating or score.

View the NBOA Terms & Conditions (link will open in new window).

I have read the NBOA Terms & Conditions.

NBOA Home Page