Personal Info * First Name Last Name Insured Address * Date of Birth * MM DD YYYY Phone * (###) ### #### Email * Occupation * Drivers license number * Level of Education * High School Degree Some College College Degree Other I currently have an insurance policy? * Yes No If yes, current insurance company and rate per year State where boat is stored * Year/make/model * Boat type * Inboard Inboard/outboard Inboard waterjet Outboard Personal watercraft Sail Boat length * Maximum speed * Horsepower * Annual Mileage * Stated value ($) * $ Years of boating experience * Comments or Special Instructions * Trailer year/ make/model/ value ($) * Thank you!
