Renter Information

Rental Details

Coverage and Premiums

This policy has a 10% deductible for liability coverage.

Experience and Qualifications

Any insurance losses or claims in the past?

Yes No

Any automobile driving tickets in the past three years?

Yes No

Have you ever been convicted of a felony?

Yes No

Have you ever been refused insurance or cancelled?

Yes No

Have you completed a basic boating safety course?

Yes No

Do you have a current Coast Guard Captain's License?

Yes No

Additional Operators

Will there be an operator other than the renter?

Yes No

Liability Agreement and Statement of Understanding

I acknowledge the risks associated with watercraft operations and accept the terms of liability coverage.

I agree to adhere to all operating instructions and safety guidelines provided.

Fraud Warning and Legal Acknowledgment

Fraud Warning: Any person who, with intent to defraud or knowing that they are facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

Disclosure of Material Facts: Every proposer or insured when seeking new insurance or renewing an existing policy must disclose any information which might influence the company in deciding whether or not to accept the risk, what the terms should be, or what premiums to charge. Failure to do so may render the insurance voidable from inception and enable the company to repudiate liability.

Signature and Date

Payment Method

Credit Card (Stripe) Zelle CashApp