DRAFT of Boat / Yacht Application

First & Last Name 1

Birth Date required

First & Last Name 2

Birth Date

Street Address

City

State

Zip Code

Phone

Make / Model

Boat Length (Ft+In)

Purchase Price

Number of Engines

Max Speed

Years Boating Experience

Prior Ownership Make

Year Built

Date Purchased required

Engine Make

Hp each Engine

Tender Description

Years Boating Ownership

Length

Number of Years Owned

Prior Ownership Make

Length

Number of Years Owned

Length

Prior Ownership Make

Number of Years Owned

Mooring Address (Street Address, City, State/Local, Zip Code, Country)

Location during hurricane season

Boating classes / certifications / licenses

Layup details

Navigation area

If you have had a claim,

Operator 1 driver license number & state

Operator 2 driver license number & state

If "yes", on captain & crew,

list the insurance companies you are currently working with or recently insured by?

Upload Survey and/or Captain License Here

Upload your files here

Upload supported file (Max 15MB)