Midwest Underwriters is a leading, minority held, independent insurance agency in the state of Michigan.


Boat/Yacht Questionnaire

Complete the form below, including your Email address. Click the Submit button and you will be included in our mailing list. When product of your interest is available, we will send you an update.

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Personal Information

First Name*
Middle Name
Last Name*
Phone #*
Email Address*
Address*

Yacht Information

Year *
Manufacturer*
Model*
Length*
Hull Type*
Engine Type*
Horse Power*
Max Speed*
Fuel Type Used* Gas Diesel
Equipment* Halon VHF Depth Finder
Radar Loran/GPS
List Other Equipment
Mooring Location*
Lay Up Oates*
Navigational Area*
Purchase Date*
Purchase Price*

Operator Information

Date of Birth*
Years Boating Experience*
Lengths/Types of Vessels Operated/Owned
Drivers License # *
Seamanship Course Yes No

Insurance Coverage

Hull Value
Trailer Value*
Dinghy Value
Liability Limits* $100,000 $300,000 $500,000
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