Taking inventory of your home

IMPORTANT – PLEASE READ BEFORE COMPLETING

Please note that by submitting this form you understand that coverage is not bound and no policy is issued or in effect. This information is for quoting purpose only. Coverage cannot be bound until such time as we submit a formal application to you and it is signed and returned to our office along with the appropriate down payment. All information submitted is held in the strictest confidence and is only used for the purposes of providing you an insurance quote.

To provide an accurate quote, please complete all questions as listed below.

WATERCRAFT QUOTE

Name:*

Mailing Address:*

Street Address (if different from Mailing):

Phone Number:	Home:*		Work:
	Cell:

Email Address:*

WATERCRAFT DESCRIPTION

Year:* Make:* Model:*

Type of Watercraft:*

Length:* Hull Value:*

Hull Type:* Hull Materials:*

MOTORS

Engine 1

Year: Make: Model:

Engine Value: Engine Type:

Horse Power: Fuel Type:

Engine 2

Year: Make: Model:

Engine Value: Engine Type:

Horse Power: Fuel Type:

TRAILER DESCRIPTION

Year: Make: Model:

Trailer Value:

ADDITION EQUIPMENT

	Item	Quantity	Value
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

DRIVER INFORMATION

Name: DOB:

Drivers License Number: SS#

Name: DOB:

Drivers License Number: SS#

Name: DOB:

Drivers License Number: SS#

Name: DOB:

Drivers License Number: SS#

UNDERWRITING INFORMATION

Number of year boating experience:

Number of years Boating Experience with this size and type:

What is the maximum Miles per hour that this watercraft can obtain:

Where will this Watercraft be used:

Where will this vehicle be stored when not in use:

lay-up period From: (MM/DD/YYYY)
To: (MM/DD/YYYY) (when the watercraft will be stored for the winter)

Boating/safety coarse taken:

Any Watercraft losses?
Yes No

If yes please explain the loss and the dollar amount paid:

Please use the space below to add any additional comments or concerns:

Watercraft Quote