Vessel Application






Personal Information

First Name:* Middle Name: Last Name:*

Mailing Address: City: State:

Zip Code: Country: Cell Phone Number:

Other Phone Number: E-mail:*

Birth Date: / / Driver's License Number:

Occupation:

Option 1: We will contact you to finish the application.


Option 2: Fill out the rest of the form for a detailed quote

Vessel Information

Year: Make: Model:

Length: Purchase Price including engines:

Storage / Mooring Location:

Storage Address if different from mailing address:
Mailing Address: City: State:

Zip Code: Country:

Date of Purchase
Month: Year: Any losses in the past five years:

Vessel Survey: Hull ID:


Engine(s) Information

Year: Make: Model:

Number of Engines: Horse power per engine: Sterndrive:

Maximum Speed: Fuel:


Trailer Information

Year: Make: Model:
Value of Trailer:


Other Information

Years of boating experience:

Vessels owned or operated in the past:
Year: Make: Model:

Length: Years owned:

Year: Make: Model:

Length: Years owned:

Is their prior insurance: If yes, carrier name:

Is their a paid crew: If yes, how many:

Tender / Dingy: If yes, Year: Make: Model:

Financed:

Waters Navigated: (Ex: Miami, Bahamas, Caribbean, etc.)

Navigation/safety equipment: (Check all that apply) Auto Fire ExtinguisherEngine AlarmFume DetectorVHF RadioSat NavigationRadarRDFGPSTheft AlarmDepth FinderAuto PilotCompass

Number of hand held fire extinguishers?


Other Drivers/Operators

Name: Driver's License Number:

Birth Date (mm-dd-yy): / / Years of Experience:

Name: Driver's License Number:

Birth Date (mm-dd-yy): / / Years of Experience:

Name: Driver's License Number:

Birth Date (mm-dd-yy): / / Years of Experience: