Alabama insurance from Burkett Insurance
Meeting the Insurance Needs of Alabama Residents & Businesses for Over 15 Years!
 
Personal Auto, Homeowners Insurance from Burkett Insurance
Personal Auto Insurance

Homeowners Insurance

Boat Insurance

Motorcycle/ATV Insurance

Personal Umbrella


Commercial and Business Insurance from Burkett Insurance
General Liability Coverage

Contractor Liability Program

Professional Liability Coverage

Commercial Automobile

Commercial Property

Workers Compensation

Surety & Fidelity Bonds



Life and Health Insurance Products from Burkett Insurance
Life Insurance

Individual Health Insurance

Group Health Insurance

Disability Insurance



Other Insurance Services from Burkett Insurance
Service My Account

More About Our Agency

Office Map/Directions

Our Privacy Notice

Questions? E-Mail Us!
Online Boat & Jet Ski
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!
Your Personal Data

Your Name:
Street Address:
City:
State: MUST be Alabama!
Zip Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 
Marital Status:
Single Married
Homeowner?
Yes No
 
Boat Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type N/C)
 
Is this Boat Co-owned?
(If yes, list all owners names)

OPERATOR INFORMATION #1
Name: Birthdate:
Sex (M/F): # Years U.S.
 Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations, and approximate DATES of each in the fields below:
Number & Type of Accidents last 3 years: Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years: Number of Years
Boating Experience:

OPERATOR INFORMATION #2 (if none, leave blank)
Name: Birthdate:
Sex: # Years U.S.
 Licensing:
Be specific to tell if accidents are "at-fault" or "NOT-at-fault" - (carriers require proof on NOT-at-fault accidents); Also, be specific as to TYPE of violations in fields below:
Number & Type of Accidents last 3 years: Number & Type of MINOR violations last 3 years:
Number & Type of MAJOR violations last 3 years: Number of Years
Boating Experience:

VESSEL & UNDERWRITING INFORMATION
Year of Boat: Make & Model
(be specific):
 
Boat Length: Hull Type
(wood, Metal,
fiberglass, etc):
 
Max. Speed
(in MPH):		 Market Value: $
 
Engine Make: Engine Type:
(Inboard, I/O, Jet)
 
Engine Horse
Power:		 Fuel Type:
(Gas, Diesel, etc.)
 
Trailer Cov.
Needed?		 Yes No Yr./Make/Model
of Trailer:
 
Trailer Value: $ Where is boat
moored or stored?
 
Describe waters
boat taken on?		 Describe boat
general usage?
(fishing, ski, etc.)

VESSEL COVERAGES:
Limits of
Liability:		 $15/30 BI / 10 PD $25/50 BI / 15 PD
$50/100 BI / 25 PD $100/300 BI / 50 PD
$250/500 BI / 100 PD
 
Hull Coverage: NO Coverage $250 Deductible
$500 Deductible $1000 Deductible
 
Water Ski
Medical Coverage?		 Yes No   Uninsured
  Motorists Cov.?		 Yes No
 
Comments or Remarks:
(List additional drivers,
special coverages, etc. here)

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We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

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Burkett & Associates Insurance Ageny, Inc. . 2400 Bob Wallace Ave., Suite 206 . Huntsville, AL 35805
Phone: 1-256-704-7400 | Fax: 1-256-704-7402 | E-Mail us at: info@burkettinsurance.com
Our Telephone Quoting Hours are: 9:00am to 5:00pm (Monday-Friday) | View Our Privacy Notice
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