Applicant Information:
Boat Insurance Coverage Information:
Minnesota Boater Information:
Full Name:          
Mailing Address:
City:
State:  (Minnesota or Wisconsin)     Zip Code:
Email Address: (Required) 
Home Phone:   Work Phone:   Ext.
How to Contact You:
Date of Birth:              (mm/dd/yyyy)
Gender:         Marital Status:
Current Insurance Company: 
Policy Expiration Date:          (mm/dd/yyyy)



  Boat       Year          Builder               Model            Vessel Type   Length
     1        
     2        

Engine Information:
  Boat       Year       Engine Type       Manufacturer      How Many Engines
    1              
    2              

Mooring/Storage Location
  Boat
     1      
     2      

What types of safety equipment is on your vessel(s)?
(check as many boxes as desired)
  Boat
     1   VHF    Depth Finder    SAT NAV    Auto Halon
          EPIRB    SSB    GPS    Radar
          Loran    CO-2    Fume Detector    Other
     2   VHF    Depth Finder    SAT NAV    Auto Halon
          EPIRB    SSB    GPS    Radar
          Loran    CO-2    Fume Detector    Other

Is boat used on any private lakes?
  Boat
     1      
     2      

Is this a promotional/Memo boat?
  Boat
     1      
     2      

Is boat used for guide service or chartering?
  Boat
     1      
     2      

Is boat used for residence?
  Boat
     1      
     2      

Is boat used for waterskiing?
  Boat
     1      
     2      

Is your driving record accident & violation free during the past 5 years?
  If No, how many accidents?    How many violations? 



Boat Insurance Coverages Desired For?
(check as many boxes as desired)
Boat(s)    Motor(s)    Equipment    Trailer


                    Liability                  Uninsured                                           Collision         Comprehensive
  Boat    Limits(x $1,000)      Boater(x $1,000)       Medical              Deductible           Deductible
     1                                 
     2                                 

Any boating claims of losses to vessel(s) or from liability in the past 5 years?
Description of losses:


Additional Information or Comments



Click on the "Submit Quote Information" button below to
send your Minnesota Boat insurance quote request.**



We are your local St. Paul, Minnesota insurance agency, offering affordable
Boat Insurance policy premiums in the following Twin Cities area towns and
counties: Minneapolis, Bloomington, Roseville, Maplewood, North St. Paul,
Oakdale, Woodbury, Cottage Grove, South St. Paul, Inver Grove Heights,
Eagan, West St. Paul, Richfield, Burnsville, Edina, Lilydale, Mendota Heights,
St. Paul Park, Lake Elmo, Newport, Cedar Grove, Savage, Shakopee, Eden
Prairie, Minnetonka, Hopkins, St. Louis Park, Plymouth, Golden Valley,
Columbia Heights, New Hope, Crystal, Robbinsdale, Brooklyn Center,
Fridley, New Brighton, Maple Grove, St. Anthony, Arfen Hills, Shoreview,
Vadnais Heights, Little Canada, White Bear Lake, Mahtomedi, Grant, Bellaire,
North Oaks, Gem Lake, Mounds View, Lino Lakes, Blaine, Coon Rapids,
Spring Lake Park, Lexington, Afton, Lakeland, Bayport, Stillwater, Apple
Valley, Andover, St. Cloud, Mankato, Rochester, Duluth, Anoka, Champlin,
Andover, Oak Grove, St. Michael, Hanover, Scandia, Forest Lake, Wyoming,
Rosemount, Hastings, Vermillon, Coates, Ramsey County, Hennepin County,
Dakota County, Anoka County, and Washington County, MN. We also offer
boat insurance services in the remainder of Minnesota and throughout
Wisconsin.
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Baecker Insurance Agency, Inc.
373 Pedersen Street, Suite 104
St. Paul, Minnesota 55119
Ramsey County, MN
(651) 730-6666
Toll Free: 1-877-730-4678
**Information received from this Minnesota Boat Insurance quote request form sent
to the Baecker Insurance Agency will be for our use only and will not be sold, given
to or distributed to any other parties. A quote will be based on the boat insurance
policy information provided and does not guarantee acceptance of the risk by us.
The precise coverage afforded is subject to meeting underwriting guidelines, and
the terms, conditions and exclusions of the policy as issued. By submitting this
request you acknowledge that this is neither an offer to insure nor a guarantee of
insurance. Completion of this form does not entitle you to a Minnesota Boat
Insurance Policy. We are licensed in Minnesota and Wisconsin and will not provide
quotes for other states.

Minnesota Boat
Insurance Quote
(also Wisconsin)
Proudly serving all of Minnesota
and Wisconsin for over a decade!
Saint Paul, Minnesota
In addition to Minnesota Boat
Insurance, we also offer
affordable Auto Insurance
policy premiums.
Contact us about Auto, Home,
Renters, and Life Insurance
toll free at 1-877-730-4678 or
locally at (651) 730-6666.

Baecker Insurance Agency
of Saint Paul, MN offers
affordable and experienced
personal insurance services
throughout Minnesota.
Click to learn more!
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