YACHT INSURANCE QUOTE
Your Information
Name*
DOB
Address*
Occupation
City/St/Zip*
Hm Phone*
Wk Phone
Email*
FAX
Boats Owned*
Boating/Sailing/Safety Classes Other Experience Previous Losses (3 Yrs) Current Insurance Company Name of Lender

Vessel Information
Marina as addt'l insured
Name				Moorage Loc
Builder				Year
Type				Max Speed
Engine Manuf				Engine Yr
Single/Twin
Last Survey Dt				Survey By
Market Value				Repl Value
Auto Halon/CO2		VHF		SSB
Depth		GPS		Radar
WeatherFax		Other Nav
Tender:    Yr		Length		Make/Model
Outboard: Yr		H.P.		Make/Model

Navigation Limits Paid Crew (if any) Offshore Cruising/Racing Anticipated

Coverage
Deductibles		1%		2%		3%		other
Hull Value  $
Liability  $
Pers. Effects $
Medical  $
Tender/ Outboard  $

Notes:

* denotes a required field