Angler's Advantage

Anglers Advantage
Insurance Program
P.O. Box 795
Shawnee Mission, KS. 66201
Fax: 1-800-777-BOAT (2628)

Angler's Advantage Quote Form

Applicant Information

Name: *
Date of Birth: *
Assn. Member Number
How did you hear about us? *
Address
Address2
City, State, Zip:
Home Phone
Work Phone
Email: *
Does more than 49% of your income
come from tournaments?*
1. YesNo
Are you a fishing guide?*
1. YesNo

Operator's Experience

Total years of boat ownership * Total years of operating experience *
Licenses Held
Previously owned boats Make Model HP Years Owned
Previously owned boats 2 Make Model HP Years Owned
Previously owned boats 3 Make Model HP Years Owned
Boating Courses Completed & Year
Any Auto or Watercraft Losses? *
1. YesNo
If yes: Date Circumstances $ Amt. Paid
Losses 2 Date Circumstances $ Amt. Paid
Losses 3 Date Circumstances $ Amt. Paid
Any Auto or Watercraft Violations
or Suspensions? *
1. YesNo
If yes: Date Circumstances
Violations 2 Date Circumstances
Violations 3 Date Circumstances

Intended Use

Waters Navigated *
1. InlandGreat LakesCoastal
  Chesapeake Bay onlyOther* (details)
* If Other, please explain
State where vessel is kept * Zip *

Coverage Desired

Hull & Equipment $
O/B Motor #1 $
O/B Motor #2 $
Trailer $
Trolling Motor $
Personal Effects $($2000 or $2500 included)
Watercraft Liability *
1. $50,000$100,000$300,000$500,000
  $1,000,000 (Pro Angler/Fishing Guide ONLY)
Deductible *
1. $100$250 $500 (standard)$1000

Optional Coverage

Optional Coverage
1. Advantage Plus What's this?
  Contaminant/Fuel Spill Coverage What's this?
  Fishing Tournament Fee Reimbursement What's this?
  Pro Angler/Guide Endorsement What's this?
  NAVIGUARD™ MBI What's this?
  Custom Wrap Endorsement What's this?
  Total Replacement Cost What's this?

Current Insurance

Issuing Company Exp. Date
Current/Renewal Premium $
Has vessel been continuously
insured for the past 12 months?
1. YesNo
If "No", please explain

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